Yoga RX: A Step-by-Step Program to Promote Health, Wellness, and Healing for Common Ailments

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■■MH^B^H "YOGA RX shows in simple, easy-to-undcrstand terms what a powerful difference Yoga can make in your life. Highly recommended." —Dean Ornish, M.D., founder, president, and director, Preventive Medicine Research Institute

Yoga

Rx

A Step-by-Step Program to Promote Health, Wellness, and Healing Jor Common Ailments

Larry Pavne, Ph.D., & Richard Usatine, M.D.

YOGA RX

L A R R Y PAY N E , P H . D . , A N D R I C H A R D U S AT I N E , M . D . Edited By Merry Aronson and Rachelle Gardner Broadway Books NEW YORK

YOGA RX A Step-by-Step Program to Promote Health, Wellness, and Healing for Common Ailments

To Merry, with love. L.P. To Moira, a loving sister and a wonderful mother. R.U.

YOGA RX. Copyright © 2002 by Larry Payne, Ph.D., and Richard Usatine, M.D. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the publisher. For information, address Broadway Books, a division of Random House, Inc., 1540 Broadway, New York, NY 10036. PRINTED IN THE UNITED STATES OF AMERICA

Broadway Books titles may be purchased for business or promotional use or for special sales. For information, please write to: Special Markets Department, Random House, Inc., 1540 Broadway, New York, NY 10036. BROADWAY BOOKS and its logo, a letter B bisected on the diagonal, are trademarks of Broadway Books, a division of Random House, Inc. Visit our Web site at www.broadwaybooks.com Library of Congress Cataloging-in-Publication Data Payne, Larry. Yoga Rx : a step-by-step program to promote health, healing and wellness / Larry Payne and Richard Usatine. p. cm. Includes index. 1. Yoga, Haoha. 2. Healing. 3. Health. I. Usatine, Richard. II. Title. RA781.7.P395 2002 613.7'046-dc21 2002074781 ISBN 0-7679-0749-3 FIRST EDITION Designed by Dana Leigh Treglia Illustrated by Kathryn Hewitt Photographs by Blaine Michioka 3579

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864

Contents

Acknowledgments A Note from Larry and Richard How to Use This Book PA R T I : I N T R O D U C T I O N T O Y O G A T H E R A P Y

Chapter 1 How Yoga Heals Chapter 2 How You Can Benefit from Yoga Therapy

I6

Chapter 3 Getting Started with Yoga Therapy

23

PA R T I I : P U T T I N G Y O G A T H E R A P Y I NTO ACTION

C h a p t e r 4 T h e W i n d i n Yo u r S a i l s : Yo g a B r e a t h i n g 3 3 Chapter

5

Relaxation

and

Meditation

48

C h a p t e r 6 C o r e Yo g a R o u t i n e s T h a t R e a l l y H e a l 6 0

PA R T I I I : Y O G A T H E R A P Y F O R COMMON Al LMENTS

Chapter 7 The Musculoskeletal System: Back, Knees, Anatomy

Arthritis

97

101

98

T h e Yo g a A d v a n t a g e f o r M u s c u l o s k e l e t a l A i l m e n t s I 0 9 T h e Yo g a P r e s c r i p t i o n f o r M u s c u l o s k e l e t a l A i l m e n t s I I I Yo g a

for

Musculoskeletal

Ailments

Chapter 8 The Respiratory System: Allergies, Asthma, Bronchitis, the Common Anatomy

I

14

Cold

10

1

151 I

52

T h e Yo g a A d v a n t a g e f o r R e s p i r a t o r y A i l m e n t s I 5 7 T h e Yo g a P r e s c r i p t i o n f o r R e s p i r a t o r y A i l m e n t s I 6 0 Yo g a

for

Respiratory

Chapter 9 The Circulatory System: High Blood Pressure,

Ailments

Heart

Disease

I

62

I

72

Anatomy 10 1 173 T h e Yo g a A d v a n t a g e f o r C i r c u l a t o r y A i l m e n t s I 7 6 T h e Yo g a P r e s c r i p t i o n f o r C i r c u l a t o r y A i l m e n t s I 7 9 Yo g a

for

Circulatory

Ailments

182

Chapter 10 The Digestive System: Irritable Bowel Syndrome, Anatomy The

10

Yo g a

Heartburn

1

Advantage

for

189

19

Digestive

1

Ailments

I

94

T h e Yo g a P r e s c r i p t i o n f o r D i g e s t i v e A i l m e n t s I 9 5 Yo g a

for

Digestive

Ailments

Chapter 11 The Nervous System: Te n s i o n Headaches,

I

97

Migraines

Neuroscience

202

101

203

T h e Yo g a A d v a n t a g e f o r N e r v o u s S y s t e m A i l m e n t s 2 0 6 T h e Yo g a P r e s c r i p t i o n f o r N e r v o u s S y s t e m A i l m e n t s 2 0 9 Yo g a

for

Nervous

System

Chapter 12 For Women Only: Menstrual Cramps, Physiology The Yo g a The Yo g a

PMS,

10 Advantage

Yo g a

Women

2

I

Menopause 1 for

Prescription

for

Ailments

for

2 Women Women

0

218 19 23

2 22

Only

A 226

Chapter 13 Mental Health: Anxiety and Depression 232 The The Yo g a

Yo g a Yo g a

Advantage

for

Mental

Prescription

for

Mental

for

Mental

Health Health

Health

235 23

7

238

Chapter 14 The Endocrine System: Diabetes, Obesity 249 Physiology I 0 I 250 T h e Yo g a A d v a n t a g e f o r E n d o c r i n e A i l m e n t s 2 5 3 T h e Yo g a P r e s c r i p t i o n f o r E n d o c r i n e A i l m e n t s 2 5 4 Yo g a

for

Endocrine

Ailments

256

Appendices A. Resource Guide

265

B. Finding a Yoga Therapist in Your Area

271

C. Figuring Your Body Mass Index

273

Notes

275

Bibliography

281

Quick Reference to Postures, Breathing, Relaxation, and Meditation

285

Inde

289

Acknowledgments

- e would like to express our appreciation for the many people who made this book possible. If Special thanks to Rebecca Cole, our editor at Broadway Books, for her wisdom, patience, and guidance, and to Dana Treglia for the beautiful design of this book. We are grateful for the enormous talent of Rachelle Gardner, who helped us find our voice and continuously gave invaluable assistance. Our technical editors Richard Rosen and Art Brownstein, M.D., helped us keep our facts straight, and our extraordinary photographer, Blaine Michioka, captured the beauty of Yoga in pic tures. We thank our undaunted literary agent, Carol Susan Roth, and the consult ants and friends who gave selflessly of their time and knowledge: Sri Mishra, M.D.; Richard Miller, Ph.D.; Robert Forster, P.T.; Roger Cole, Ph.D.; David Allen, M.D; James Galizia, M.D; Mike Sinel, M.D; Lesly Kaminoff; Kausthub Desikachar; Linda Lack, M.A.; Judy Gantz, M.A.; Leroy Perry, DC; Steve Paredes, DC; Professor Sasi Velupillai; John Schumacher; Joseph Le Page; Roberta Haas; Shinzen Young;

Ron Lawrence, M.D; Leslie Bogart, R.N.; David and Karen McHugh; Marc Suchard; Ram Rao, M.D; Matra Majmundar, O.T.R.; Brother Keshavananda; Erick Maisel; Clark Siegel; Chris Brisco; and Ingrid Kelsey For editorial assistance and research we thank Lauren Marino; Stephan Bodian, Ph.D.; Trisha Lamb Feuerstein; David Hurwitz; Marguerite Baca; Suzi Landolphi; and Kathryn Hewitt for illustrations. Thanks also to models Karen Howard (cover), Randi Jo Greenberg, and Laura Dunning, and stylists Jeanne Townsend and Jojo Meyers Proud. We especially appreciate the dedicated staff of Broadway Books who made this book a reality. F R O M L A R R Y PAY N E :

My deepest gratitude to T. K. V. Desikachar for his inspiration and example. To my immediate family: Dolly, Harold, Chris, Lisa, James, Natalie, and Maria. To my legal counsel and friend Steve Ostrow, and my personal assistant Chris Fletcher. To my beloved teachers who guide my spiritual path: Parmahansa Yogananda; Evarts Loomis, M.D; Indra Devi; Georg Feuerstein, Ph.D.; Richard Miller, Ph.D.; Lilias Folan; and Rama Vernon. To all my Yoga students and Yoga therapy clients whose courage inspires me. And finally, I thank God for my friendship with Richard Usa tine. It has been an honor to work on this project together. F R O M D R . R I C H A R D U S AT I N E :

Special thanks to Larry for his friendship and for giving me the tools and the encouragement to heal my back pain. I'm also deeply grateful that he devoted him self to creating and teaching the first class on Yoga and Medicine for UCLA med ical students. Finally, I would like to thank Larry for conceiving of this book and asking me to be his partner. I am pleased that we were able to present the ancient art of Yoga in a context that stays true to current scientific principles. I would like to thank my lovely wife, Janna, and my wonderful children, Rebecca and Jeremy, for their support and love. My family brings joy to my life every day and gives meaning to my work.

A Note from Larry and Richard

The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease. —Thomas A. Edison \ / oga has dramatically changed both our lives. We wrote this book because we wanted to help you restore your health, relieve your pain, and feel bet ter through Yoga therapy As a Yoga therapist and a medical doctor, we have different backgrounds and lead very diverse lives. Yet both of us have experienced such powerful effects from Yoga that we have committed ourselves to sharing this extraordinary healing tool with others. We believe Yoga is one of the most effective ways to treat your body and mind simultaneously, reducing stress and increasing flexibility, muscle strength, concentration, and a general sense of well-being. We want to spread the news that Yoga is not only effective for overall health, it can also be used in a targeted man ner, with specially designed postures and routines, to manage and even cure spe cific physical disorders. As part of his medical practice, Dr. Richard Usatine teaches the basics of Yoga

to patients suffering from ailments as varied as back pain, anxiety, and asthma. He refers many patients to Yoga therapy for healing of their painful and injured bod ies. Dr. Larry Payne is a Yoga teacher and therapist working each week with hun dreds of people, in classes and in one-on-one therapy sessions, to improve their health. A few words about our backgrounds before we met will help you understand how we both became so passionate about Yoga. RICHARD'S STORY

I took my first Yoga class when I was in college and was wary because I thought I'd be spending a lot of time sitting in the lotus position, a popular image back in the 1970s. I was relieved to find that the postures of Yoga are many and varied—and they feel great. I saw how Yoga could help me increase my flexibility and learn to relax both my mind and my body. Since then, I have used Yoga intermittently with other physical activities, including swimming, cycling, squash, and tennis. After medical school, I completed my family medicine residency at the Uni versity of California at Los Angeles (UCLA) and then practiced full-time at the Venice Family Clinic. From the beginning, I took a holistic approach to treating patients. I listened to their stories, made house calls, and developed strong rela tionships with the patients and their communities. Meanwhile, the medical stu dents and residents I was training at the clinic learned the value of caring for the whole person, taking into account their physical, mental, and emotional needs. In 1989, I returned to UCLA to co-direct the family medicine training pro gram for interns and residents. Influenced by holistic ideas in the works of Bernie Siegel, Joan Borysenko, and John Sarno, I began to teach mind-body medicine to residents. The idea was to get young doctors to promote an overall healthy lifestyle to their patients. Meanwhile, furthering my study of Yoga gave me an opportunity to learn more about the mind-body connection and the value of Yoga in my own life. One instance of this was when I was able to use Yoga to heal a skiing injury to my knee. I began referring my own patients to Yoga for various conditions, both physical and stress related, and I constantly received positive feedback on Yoga s effects. In 1990, I began teaching doctors how to help their patients quit smoking through abdominal breathing, the same Yoga breathing I had learned many years

before. Patients were able to cope with the stress and anxiety of quitting their addiction, and we had quite a success rate! This was just one of the countless med ically sound uses I have found for Yoga in my years as a family physician and a teacher. LARRY'S

STORY

In 1978, I was an advertising sales executive living in Los Angeles and working for a major New York-based women's magazine. The money was great, and the perks were even better. I drove a fancy company car, had a generous expense account, and enjoyed my work. But, as the advertising business became more competitive, the pressure intensified and I became totally overwhelmed. Eventually, I developed high blood pressure and a serious back problem. For the next two years, my jobrelated stress continued while doctors tried to fix my back. Orthopedic specialists, physical therapists, and prescription drugs all failed to bring relief. The only options left were surgery, more drugs, or learn to live with it. Then a dear friend virtually dragged me (not quite kicking and screaming; I was willing to try anything) to a Yoga class. I remember being embarrassed, think ing I couldn't possibly do those strange postures the right way. My muscles were tight, and I was wired from the stress of my job. Fortunately, the teacher was com passionate and wise. She instructed me in the postures and the Yoga breathing, advising me not to be competitive or to push myself too hard. At the end of the class, she led us in a guided relaxation for about ten minutes. I couldn't believe it. The pain in my back disappeared for the first time in two years. The relief lasted several hours, and I had this unfamiliar feeling of being relaxed and happy It was a life-changing experience, and I was eager to share it with everyone around me. I began to pursue the Yoga path seriously, first attending a Yoga and health retreat founded by Dr. Evarts Loomis, father of holistic medicine in America. Then I took a one-year sabbatical to study Yoga. My sojourn led me to eleven countries and eventually to India, the birthplace of Yoga. There I trained as a Yoga teacher and had the fortune to study with many of India's foremost Yoga masters, includ ing my teacher of twenty years, T. K. V Desikachar. Well, that was it for advertising. When I returned to Los Angeles in 1981, I retired from the advertising world, became a full-time Yoga teacher, and founded the Samata Yoga Center. For the past two decades, I have worked to bring Yoga

and Yoga therapy into the mainstream as a legitimate and respected health-care alternative. O U R C O L L A B O R AT I O N

The two of us first met in 1997. A year earlier, Richard had been a passenger in an auto accident, and shortly afterward, the nagging low back pain began. Months later when the pain hadn't disappeared, he finally went for medical attention. The orthopedic doctors performed x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), and even a bone scan, but they found nothing structural to explain the pain. Eventually, he was referred to Larry for Yoga therapy At that first appointment, Larry took a history and assessed Richard's posture, flexibility, and gait. Larry developed a Yoga program specifically for Richard, and within a few short weeks Richard was essentially pain free and feeling completely well for the first time in more than a year. To this day, Richard uses the program Larry developed to keep his back flexible and healthy (In Chapter 8, you will find a sim ilar program, called Yoga for the Back.) As we continued to work together, we began to discuss how valuable it would be for medical students to be exposed to Yoga, both for their own well-being and to provide them with a technique for their patients. Together, we created an elec tive class in Yoga and Yoga therapy at the UCLA School of Medicine. In an inno vative alliance of Western medicine and ancient Eastern philosophies, the course became an immediate success, and in 1998 it became a regular part of the school's elective curriculum—a first for a U.S. medical school. Larry teaches the theories of Yoga for one hour and leads the students in practicing Yoga for a second hour. Yoga now helps these students manage their stress and exposes them to Yoga as a benefi cial therapy for their own future patients. It was exciting to observe a student from our first Yoga class teaching a patient how to use Yoga breathing and postures to overcome his back pain. Y O G A : N O PA I N , A L L G A I N

As most people know by now, there are vast quantities of scientific evidence show ing that exercise enhances your health and prevents illness. The benefits of physi cal activity are cumulative, so that small amounts of time spent exercising on a

regular and long-term basis will add up to big rewards. According to the Centers for Disease Control and Prevention (CDC), exercise: Increases muscle and bone strength. Increases lean muscle and decreases body fat. Helps control your weight. Enhances your psychological well-being and plays a part in reducing the development of depression. Reduces symptoms of anxiety and improves your general mood. Yoga provides all of the benefits of exercise and more. The Yoga postures involve stretching to maintain and enhance flexibility. Many poses are a form of isometric strengthening exercise, which involve the contraction of muscles with out moving the joint. In other words, you're working very hard to remain motion less. This technique, which strengthens muscles without putting too much stress on the joint, is often used in physical therapy for the rehabilitation of injured joints. Other Yoga poses involve movement, which is always done slowly and with focus. Because Yoga is safe and gentle, it can be enjoyed late into life, when normal aging causes many of us to lose flexibility and strength, making us more susceptible to injury. But Yoga is more than just the physical movements and postures. The central element is Yoga breathing, which we encourage you to practice before you begin trying the routines. Yoga breathing simply means using various techniques to breathe in a slow and focused manner, which calms your mind and relaxes your body. More than twenty-five years ago Herbert Benson, a Harvard physician, researched the physiology of what he called our "relaxation response." He found that high blood pressure could be reduced with abdominal breathing and simple meditation. The relaxation breathing stimulates the parasympathetic nervous sys tem, which is responsible for telling our bodies to relax. The vagus nerve is a part of this system; and when it is stimulated, it reduces the heart rate and the intensity of the heart pump, thereby lowering blood pressure. Although he did not specifi cally use Yoga techniques, the slow and measured breathing that went with the meditation he taught was identical to Yoga breathing. That does not mean that all people with high blood pressure can be treated exclusively with this type of breathing and the relaxation response. But Dr. Benson found that this was

sufficient therapy for some patients and was beneficial for those patients who still needed medication. The benefits of Yoga breathing are numerous, and we'll go into them in detail in Chapter 5 and provide you with instructions and exercises. There is overwhelming scientific evidence that the severity of many medical problems increases with stress. For example, virtually all types of pain worsen when a person is under great stress. We feel pain when our body sends pain messages to the brain through the spinal cord. When the brain is performing optimally, it sends blocking signals down the spinal cord, which decrease the transmission of pain to the central nervous system. When the brain is under stress, it appears that these blocking signals don't work as well so we experience pain more intensely. Stress can also exacerbate high blood pressure and lead to a heart attack. Yoga has the won derful benefit of reducing stress through the relaxation response, plus it offers all the advantages of exercise. Like all forms of exercise, Yoga should be performed only to your capacity. There are always exceptions; but if you are older, you should not expect to be as flexible and strong as younger people. It is essential that when you initially practice Yoga, you avoid pushing yourself beyond your limit. You cannot "muscle" your way into Yoga. Injuries occur when you try to force your body to do something your body is not prepared to do. Advocates of no pain-no gain will find no sup porters here. The sensible, noncompetitive, and individualistic approach to Yoga should bring you nothing but increased flexibility, strength, and improved health— no matter where you start.

xvi

How to Use This Book

/ oga Rx is not meant to replace modern medical treatment, nor does this book attempt to supersede your doctors diagnosis. We intend you to use it as a complement to other medical treatments, with the approval of your physician. We urge you to read Parts I and II to get a basic understanding of Yoga ther apy, before jumping to the chapter that contains your ailment. It's important that once you begin using Yoga to help relieve your condition, you practice with an understanding of the breathing, relaxation, and meditation techniques involved, as well as the basic principles of how Yoga heals. All of this is explained in Chapters 1 to 5. In Chapter 6, you will find two basic Yoga therapy routines that you can eas ily learn and practice when you are ready for general conditioning. In Part III, you'll find common medical problems grouped according to the bodily system they belong to. For example, if you're interested in Yoga for back or

knee pain, you should go to Chapter 7. Be sure to start at the beginning of the chapter, to learn how ancient Yoga philosophy and modern medicine come together to provide a thorough understanding of your condition. Each chapter explains the anatomical system, discusses different ailments of that system, describes how and why Yoga can enhance the health of the individual dealing with those problems, and illustrates ailment-specific Yoga therapy routines. Throughout the book, we use real-life stories of people whose health has improved through Yoga. These anecdotes are not meant to be proof that Yoga will work for all people with similar ailments or disorders. However, they do illustrate the possibilities and we hope they encourage you to adopt healthier living practices, as some of our clients have done with Yoga and other lifestyle modifications. If followed correctly, the recommendations in this book are safe for everyone. Because each individual is unique, people respond and improve at different rates. However, you can expect to notice considerable results within a couple weeks of beginning Yoga therapy and significant changes within three months. Throughout the book, Larry addresses you in the first person as he relates anecdotes from his experience and his Yoga therapy practice. However, all of the medical and scientific information has been provided by Richard. You may not hear Richard's voice, but his medical expertise is on every page. We have seen thousands of women and men make tremendous strides in their health, careers, and relationships through a regular practice of Yoga. We have also seen Yoga therapy bring about amazing improvements for longtime sufferers of back pain, hypertension, chronic fatigue syndrome, depression, asthma, allergies, arthritis, and numerous other maladies. We have collaborated on this book in hopes that you will find not only relief from your pain and generally improved health but an appreciation of your body's ability to naturally heal itself when given the right conditions. It is our sincere wish that you will be able to use our concrete suggestions to improve your health and to experience a life of vitality, energy, and fulfillment through the art and science of Yoga therapy. Larry Payne, Ph.D., and Richard Usatine, M.D.

XVIII

YOGA RX

PART I Introduction to Yoga Therapy

Part I of Yoga Rx introduces you to Yoga and, specifically, Yoga therapy. It's crucial for you to read these chapters to prepare yourself for learning the exercises in Parts II and III. Even if you're familiar with Yoga, you may be surprised at some of the new information you'll find here.

How Yoga Heals

%\ / °§a *s not magic» but it can bring about miraculous types of transforma\[ tion. Jessica, nineteen, had been diagnosed with an assortment of ailments ii from her early teens. They included mononucleosis, chronic fatigue syn drome, hypothyroidism, severe allergies, and adrenal deficiency. Despite treatment and medication from three prominent doctors, she was unable to participate in normal physical activities without ending up in bed with flu-like symptoms. Her dismal health also affected her attitude about life, and she often found herself depressed and unhappy. Unable to physically endure a group Yoga class, Jessica began private Yoga therapy lessons. She started with simple reclining breath and movement routines (similar to the Lower Back Routine, described on page 114). After a month, Jes sica was able to intensify her practice and use Core Routine I (page 62). She started to have more energy for everyday activities that we take for granted when

we are healthy. After three months, she had stopped taking most of her medica tions, could participate in normal activities, and had graduated to Core Routine II (page 78). Perhaps most important, her spirits had lifted, and she felt happy and hopeful for the first time in years. "After a year of Yoga therapy, I had developed a two-hour daily routine," she recalls. "It included one hour of Yoga, forty-five minutes of treadmill, and fifteen minutes of Yoga breathing exercises—a regimen that would have previously been impossible for me to maintain." Using the principles of Yoga therapy, Jessica had succeeded in reclaiming her good health and a vital, energetic life. So what is Yoga, anyway? Yoga is not just stretching, just breathing, or just meditation. It is not just crossing your legs, closing your eyes, putting your thumbs and forefingers together and chanting "Om . . ." And it is certainly not a cult or a religion. I like to describe Yoga as a natural, do-it-yourself prescription for good health and stress management that is needed now more than ever in our demanding, stress-filled lives. Since modern medicine points to stress as a major cause of illness today, Yoga may ultimately prove to be one of the most practical preventative med icine techniques available. It has an illustrious five-thousand-year history, and since the 1970s its popularity in the West has skyrocketed. Yoga is rightly considered an art. Similar to a dance that is carefully choreo graphed, Yoga consists of specific postures, techniques, and attitudes. Yet it's the individual performer who breathes life into the form, making the expression his or her own and transforming the routine into an art. At the same time, Yoga is also a science. It is based on ancient observations, prin ciples, and theories of the mind-body connection, many of which are now being dis covered in medical research. Qualified teachers have passed down this precise knowledge to their students from one generation to the next. Often these teachers have been referred to as Gurus, meaning "the ones who remove darkness." Yoga focuses on healing the whole person and views the mind and body as an integrated unity, which is why it is called a mind-body science. It teaches that, given the right tools and the right environment, the mind-body can find harmony and heal itself. Like an orchestra and its conductor, the systems of the body need to be in sync with the mind to perform effectively. If the mind provides confusing signals or moves too fast, the body may become unbalanced, out of sync, overworked, or exhausted. And if the systems of the body are weak or out of tune, they may not be

able to respond to the mind. Yoga calms and relaxes the mind, strengthens and tunes the body, and brings them into harmony with one another. Translated from Sanskrit, the classical language of India, the word Yoga means "yoke" or "unity." It also means "discipline" or "effort." In other words, Yoga requires you to make an effort to unify your body and mind. You do this by con centrating your awareness on your physical body. Many people think of Yoga as simply stretching or gymnastics. But unlike other exercise programs, you can't do Yoga postures properly while watching your favorite sitcom on TV. At the health club, you see people wearing headphones or reading the newspaper while they exercise. This is a perfect example of the mind attending to something else while the body is exercising. Because Yoga requires the full exertion of both the mind and the body, by definition it can't be practiced while your attention is elsewhere.

YOGA POSTU RES When most people hear the word Yoga, they picture a room full of people practic ing the familiar postures known as asanas (AH-sah-nas). The approach to Yoga that focuses on these postures is called Hatha (HAHT-hah) Yoga and is generally taught in a group setting, rather than one to one. But there are other categories of Yoga that don't involve postures at all. For example, Bhakti Yoga emphasizes loving devotion to a personal god, whereas Karma Yoga consists of selfless service. Jnana Yoga cultivates higher wis dom as a path to the divine, while Raja Yoga encourages the classical practice of meditation and contemplation. Mantra Yoga uses sacred sounds, or mantras, as a means of spiritual refinement, and Guru Yoga advocates dedication to a Yoga mas ter. Each is a kind of Yoga because it involves self-discipline and seeks to "unite" the practitioner with the sacred dimension of being. In fact, even the Hatha Yoga we now associate with Yoga studios and rigorous routines was originally developed as a method for channeling spiritual energies and achieving higher states of con sciousness. Within Hatha Yoga itself there are many styles and lineages. Some of the more traditional approaches that have become well established in the United States include Iyengar, Ashthanga, Integral, Sivananda, Bikram, Ananda, Kundalini, and Kripalu. A number of Western teachers have developed their own unique styles as

well, including Somatic, Hidden Language, White Lotus, Tri, Ishta, Anusara, and Jivamukti. In my practice, I use a style I call User Friendly Yoga™, which is my own slight modification of a traditional approach called Viniyoga. This is what you will find in the Yoga routines in this book. According to one source, more people are enrolled in group Yoga classes in California than in the entire country of India. In 2001, Yoga Journal estimated that there were more than eleven million people practicing Yoga in the United States and approximately twenty million worldwide. Of all the locations in the world, I'm sure that none has more Hatha Yoga classes than Los Angeles. However, not all Yoga studios are created equal. While researching this book I discovered a startling array of classes offered under the name Yoga within a five-mile radius of my Los Angeles studio. I attended one huge class with more than fifty students, in a sweltering room in which the temperature was over one hundred degrees and the teacher sported a bikini and used a headphone mike. Just up the street, the teachers were wearing long robes and burning incense, and chanting seemed to be the order of the day. A few miles north, I found a studio with a hard wooden floor, straps hanging from the walls (don't ask!), and props such as blocks, benches, and blankets every where. The teacher had the demeanor of a drill sergeant and yelled at his students as he inspected their postures. Finally, I ended up in a trendy center where the instructor was as funny as a stand-up comedian, rap music played throughout the class, and the students were bouncing and grooving as they practiced their poses. Only in America. If you decide to venture into a Yoga class, it's important to do a little research first. Make sure the one you select fits your individual needs based on your fitness, age, state of mind, and overall energy level.

THE YOGA LI FESTYLE Classical Yoga includes eight principles, which were described in detail in the sec ond century B.C. in the Yoga Sutras of Pantanjali. The eight principles offer guide lines for a moral and meaningful existence, emphasizing moderation and self-discipline, which can be found in all of the world's great religions:

Treat others as you would like to be treated; avoid violence in word and action. Work on your self-discipline to exchange bad habits for good ones. Maintain a practice of Yoga. Practice Yoga breathing techniques. Avoid overstimulation of the senses. Develop focus and concentration. Include meditation in your lifestyle. Work toward a goal of joy and ecstasy. The practice of Yoga has a way of seeping into other parts of your life. For most people, it helps cultivate greater awareness; slows down the pace and increases enjoyment of simple, everyday activities; and generally improves their outlook. Yoga will help you become more aware of your body's posture, alignment, and movement patterns, which in turn can have a powerful impact on how you feel. As you begin a Yoga practice, you may also notice that your internal rhythms slow down and your ability to concentrate improves. Systematic focus on breath and movement helps you tune into a deeper awareness of yourself and your surround ings. As you maintain the more physical aspects of yoga, such as postures and breath ing, you may also find yourself naturally drawn to change your lifestyle in accor dance with these principles. Many of my students have reported that they gave up smoking or stopped eating junk food or meat after they had been practicing Yoga for a few months. In my experience, the more attuned you become to your body, the harder it becomes to treat yourself with disrespect. At the same time, deliberately following healthy lifestyle principles can actually support your physical practice of Yoga. If you stop smoking, for example, your breathing will naturally expand and your circulation will improve. If you develop more positive qualities like openness, gentleness, and spirituality, I think you'll find that your experience of Yoga noticeably deepens. As with any lifestyle change, don't try to transform everything overnight. It's most important to proceed at a level and a pace that feels right to you. As you strive toward an overall healthier lifestyle, keep the following goals in mind.

Have a Positive Intention If negative thoughts can make you sick and tired, then positive thoughts can help make you well and happy. Because Yoga is a mind-body science, it acknowledges the importance of attitude and environment. It is so important to acknowledge something good in your life each day and experience gratitude. Be grateful that you are taking time for a Yoga therapy practice and taking control of your own healing process. Sometimes it helps to verbalize your positive thoughts or share happy or exciting ideas or events with others. Just to hear yourself talking this way can be beneficial. Words and thoughts are extremely powerful.

Exercise Faith and Prayer Have you heard that faith is a powerful healer? Time and again people with strong faith have pulled themselves through difficult times or serious illnesses. Yoga teaches us to renew our faith in that which gives us sustenance. Whatever your reli gion or spiritual belief, now is the time to act on it, taking concrete steps to deepen and broaden your faith. To enhance your spirituality, you may want to practice some form of meditation. Chapter 5 offers some techniques.

Indulge Humor and Laughter The late writer Norman Cousins helped cure himself from a chronic illness by the use of positive thoughts and humor. His approach? He rented his favorite Marx Brothers movies and laughed out loud watching them. Since the beginning of recorded history, laughter has been considered good medicine. Even if we can't laugh away serious problems, it may help us cope with them in a more positive way.

Take Time to Do What You Enjoy Make time for activities that make you happy, bring you joy, and have a positive influence on you. Go for a walk, listen to music, spend time on a hobby, or visit with uplifting friends and relatives. Think about these things at the end of your

practice, when your mind is quiet and focused, and you can see more clearly what is important and joyful to you. For instance, many of the great Yoga masters recommend spending some quiet time in nature. Inspirational settings such as mountains, oceans, deserts, and lakes can recharge your batteries and rejuvenate your spirit. In fact, regular pilgrimages in nature are a vital part of many spiritual traditions. Making time for these activi ties can help improve your mental, emotional, and physical health, so it's important not to underestimate their importance.

Eat a Healthful Diet Would you be surprised if I told you I am not a vegetarian? Most people I meet are amazed to learn that vegetarianism is not a prerequisite to learning or teaching Yoga. For seven out of my twenty years as a Yoga teacher and Yoga therapist, I tried to maintain some form of a vegetarian diet, including macrobiotic, vegan, and lactovegetarian. During those times, I never felt as good as I do when I include meat— mosdy poultry and fish—in my regimen. I've come to the conclusion that everyone's constitution is different and we each have unique requirements. While a vegetarian diet may not be appropriate for everyone, some health conditions benefit from skipping meat and dairy products altogether. Dean Ornish, M.D, with his pioneering research on heart disease, showed that a 10 percent fat, whole foods, vegetarian diet combined with aerobic exercise, stress management training, smoking cessation, and group support could reverse coronary artery dis ease. Because the program included more than just diet, it is hard to say that the decrease in heart conditions was due to the vegetarian diet. However, there is good evidence that lowering your cholesterol with a low-fat diet does decrease the risk of heart attack. The nutritional suggestions that follow are not meant to replace any other diet information you may be pursuing. In fact, if you're interested in cleaning up your eating habits, I encourage you to speak with a well-trained nutritionist or health care professional. Another option is to read some of the more credible nutrition books out there. (See the Resource Guide for our recommendations for excellent reference books on food and nutrition.) When it comes to food, I know all too well how easy it is to read about the correct course to take but how hard it can be to shift your relationship with food

and change your daily eating habits. Like so many people, I work hard to maintain my appropriate weight and have a tendency toward compulsive eating. This shocks people, because they often assume that a life committed to Yoga removes one from the common pitfalls and challenges of being human. I assure you it doesn't, and can prove it: My greatest adversaries are Ben and Jerry and their friend, Chunky Monkey.™ David Allen, a popular Los Angeles—based holistic medical doctor, recom mends that patients ask themselves a critical question before every meal: "Is this what I would eat if my life depended on it?" He then quickly points out that it always does! With this advisory in mind, we offer the following guidelines for healthy eating: Do not eat to the brim. The Yoga approach for eating properly is to fill your stomach with half food, one quarter water, and one quarter air. This ensures you will leave the table satisfied but not too full, without that bloated feeling. (You should never have to loosen your belt to feel com fortable while or after eating.) Eat in a relaxed, calm, and stress-free environment. Avoid eating when you are upset, anxious, or rushed. Eliminate such distractions as TV, reading, and confrontational encounters. Eat less. As we get older, our metabolism tends to slow down, and we need fewer calories to maintain our health and weight. But learning to eat less cannot be accomplished by following the latest fad diet. It simply means that over time, you will benefit from slowly training yourself to choose smaller portions of healthier foods and to walk away when you're not quite full. Chew well. Efficient digestion is crucial to overall good health, and the digestive process starts in the mouth. Fast a little bit each day. The ancient Yoga philosophy suggested fast ing for several days on end, which is not practical for our modern-day lifestyles. However, refraining from eating for three to four hours before you sleep is a healthy way to avoid heartburn, which can be uncom fortable and damage your esophagus and throat. You could also concen trate on fasting between meals—skipping the snacks in between (unless

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your doctor recommends otherwise). You'll receive hunger signals when your body genuinely needs more nutrients, along with messages from your body about what nutrients it really needs. This helps you get in tune with your body, a crucial element of practicing Yoga. Eat regularly and don't skip meals. Eating a good healthy breakfast is a great way to start off your day, to enhance clear thinking and energize you for Yoga and other physical activities. Go slowly. After each bite or two, put your utensils down and ask your self: Am I still hungry? Choose a wide variety of foods. Have at least five servings of fruits or vegetables every day as recommended by most nutritionists. Emphasize whole foods and rninirriize prepackaged foods. Try to avoid processed meats (such as sausage, bacon, and ham) as well as foods with additives and artificial ingredients, which can be detrimental to your health. Just remember that with every step you take toward healthier eating habits, your Yoga practice will be enhanced. Whatever relief you're seeking, whatever physical, mental, and emotional changes you're after—they are likely to become reality much sooner if your food choices are consistent with good health practices.

D r i n k P l e n t y o f Wa t e r The human body is two thirds water. Obviously, we can't live or function properly without replenishing the water that we lose daily through our urinary tract (as urine), gastrointestinal system (as stool), respiratory system (as moisture in the air we breathe out), and our skin (sweating and evaporation). We take in water in the fluids we drink and the foods we eat to keep the water balanced in our bodies. For tunately, almost all the foods we eat have significant water content, and most foods—plant and animal—are made of over 50 percent water. The kidney does a wonderful job of helping us keep that balance. When we drink more than we need, the kidney makes more urine. Conversely, when we don't take in enough fluids, the kidney holds on to more water. When this beautiful balanced system is work ing, our bodies are in a state of homeostasis.

Our job is to make sure we take in enough fluids to keep our bodies well hydrated and let the kidneys handle any extra fluid. Some nutritionists recommend a minimum of six to eight glasses of water daily. If you eat a lot of fruit, vegetables, soups, and other foods with high water content, then you may need fewer glasses of water or equivalent fluids such as juices and herb teas. If you sweat a lot while you exercise, you will need more fluids. Your body helps you keep this balance by giving you signals such as thirst and hunger and using the kidney to keep the homeostasis. Listen to your body's signals and make an effort to eat and drink healthy foods to maximize your health. Many illnesses or injuries put our bodies at high risk of dehydration. This is especially true with high fevers, diarrhea, large burns, and vomiting. If you are suf fering from any of these conditions, you should drink more fluids and get medical help when you are unable to replenish your losses to maintain your internal fluid balance.

Practice Breathing Exercises In my twenty-year experience as a Yoga teacher and therapist, I have found that breathing exercises are the most profound healing tool Yoga has to offer—and also the simplest. Yoga breathing helps oxygenate the system, improve the mus culature of the spine, strengthen the diaphragm, and relieve pain. It can energize you or calm you, whichever you need. You'll experience many benefits from tak ing quick five-minute Yoga breathing breaks whenever you need them during your day, especially if you're under stress (and who isn't?). Chapter 4 offers safe, time-tested Yoga breathing exercises and advanced techniques for building your energy.

Get Enough Rest Perhaps one of the best-kept secrets for recovering and/or maintaining good health is proper rest and relaxation. When you don't get enough rest, you invite problems for any weak part of your system. In addition, the last thing you think about before sleep may be important. If you watch TV news just before you close your eyes, your mind may be filled with disturbing images, leading to less-than-restful sleep.

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At bedtime try reading something pleasant or spiritual, listening to beautiful music, or just looking at photographs that give you a positive feeling. It's also an optimum time for reciting or writing a gratitude list.

Learn Meditation One of the best ways to give yourself a relaxing break every day is to meditate. The ancients practiced Yoga postures, or asanas (Sanskrit for "seat"), to prepare them selves for many hours of sitting in meditation. The modern application of Yoga helps us counter the effects of our sedentary lifestyles and gives our minds a break from the constant distraction of media and the daily pressures that follow us wherever we go. The mindful practice of Yoga is inherently meditative because it requires that you pay attention to the slow, subtle movements of your body from moment to moment. If you're not bringing your mind and body into harmony, you're just stretching or doing calisthenics, not practicing authentic Hatha Yoga. The Yoga tradition also teaches a variety of meditation techniques that enhance the healing benefits of the physical postures. And in recent years, many Yoga teachers have incorporated methods from other traditions, especially Bud dhism. Chapter 5 is devoted to meditations that complement the Yoga therapy in this book.

HOW YOGA THERAPY DIFFERS FROM YOGA In 1989, when I co-founded the International Association of Yoga Therapists (IAYT), with Dr. Richard Miller, the name stirred controversy among our col leagues, because many established Yoga teachers contended that Yoga was by its very nature therapeutic. Why did we need a separate discipline called Yoga ther apy? Since then, there has been ongoing dialogue in the Yoga community about what distinguishes Yoga therapy from ordinary Yoga. In a 2000 article in Interna tional Journal of Yoga Therapy, a panel of five well-known yoga experts attempts to define this developing discipline. Although no single definition has been widely

I3

adopted, the field of Yoga therapy has grown rapidly over the years, and the IAYT now boasts over a thousand members worldwide (see the Resource Guide). In my own view, Yoga therapy adapts the practices of Yoga to the needs of people with specific or persistent health problems. Frequently, these people can't attend group Yoga classes and need one-on-one attention. Yoga therapy can serve as a transition into group Yoga classes, as it did for my friend Chris. I first met Chris years ago when we both attended El Camino College in Torrance, California. Her sorority and my fraternity often did fun things together. One night at a party, Chris had a severe asthma attack. We all gathered around, very alarmed, as she struggled to catch her breath. We rushed her to the emergency room, and, with treatment, she recovered. But I never forgot the experience. After college we lost touch with one another. Then, twenty-five years later, I bumped into Chris while on my way to teach a Yoga class in Malibu. Surprised and delighted, we reminisced about old times, and I asked about her asthma. Appar ently she had been using various medications and taking allergy shots ever since the attack in college. Occasionally, she still woke up wheezing and ended up in the hospital. Her asthma could also be triggered by the slightest aerobic exercise. I immediately recommended Yoga therapy. After a few private lessons, in which she learned breathing exercises similar to those recommended for asthma in Chapter 8, she was able to begin Yoga practice at home on her own. She also began taking Chinese herbs, and a few weeks later she joined my twice-a-week group class. After three months of regular classes, herbs, and Yoga breathing exercises, her asthma resolved and Chris stopped taking her medication and allergy shots completely. For the past eight years, she has been a regular in my Malibu class and she has been asthma- and medication-free the whole time, occasionally using an inhaler for allergies. Like Chris, many people benefit very quickly from a Yoga program designed for their specific ailments, which is what we offer in Part III of this book. But ordi nary Yoga practice can also have a therapeutic effect. I learned this from my own experience, when my chronic back pain gradually disappeared as I continued to attend a regular Hatha Yoga class. However, if I had been able to get one-on-one Yoga therapy specific to my back pain, I'm sure my healing would have occurred more quickly Both Yoga and Yoga therapy need to be adapted to the culture in which they are taught. The postures and procedures recommended at a traditional Yoga therI4

apy center in India, for example, aren't necessarily appropriate for students in the United States. Because Yoga therapists may work in concert with physicians and other conventional health-care providers, we need to use language and procedures that they can understand. When I communicate with medical providers, I explain that Yoga therapy is the practical application of Yoga principles for people with spe cial physical, emotional, or spiritual needs or challenges. In the rest of the book, I will show you how to use the time-honored practices of Yoga therapy to signifi cantly improve your health and well-being.

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2 How You Can Benefit from Yoga Therapy

/ hen you're relaxed and free of stress and your mind is focused and 1 / calm, your body has an innate capacity to heal itself Your natural state is one of balance, and it is only when a negative external force inter venes that you become out of balance—you experience ill health. Your practice of Yoga encourages health by reducing stress, enhancing concentration, increasing feelings of comfort and ease, and helping bring your whole being back into har mony and balance. Physically, the postures of Hatha Yoga promote balance by equally stretching the right and left sides and the front and back parts of your body This symmetrical approach gradually corrects any tendency you might have to favor one side or part over another. On a muscular level, Yoga helps you achieve balance by both stretch ing and strengthening the muscles throughout your body. Muscles that are loose

and well stretched are less likely to be injured, much like taffy that when cold can be snapped, but when warm is pliable and gives. But the deeper balance that Yoga affords comes from the combination of con centration, stress reduction, and relaxation it teaches. When you're focused in the present, free of stress about past or future, relaxed, alert, and feeling contented or even joyful, your body tends to perform at optimal levels and naturally gravitates toward a state of optimal health. If you own a computer, you know how frustrating it can be when the machine freezes up, especially when you're hurrying to meet a deadline. Often, it seems, computers crash when they're running several programs and handling too much information at once. Usually the only solution is to turn off the machine and give it a rest. When you turn it back on, it does some checking and adjusting of systems, everything falls back into place, and you can get back to work. In the same way, your body and mind can become overworked and out of whack; they can even "crash" and become injured or ill. Yoga provides the break your mind-body needs to avoid crashes, helping you stay in balance and function at your highest level. In this chapter, we'll take a closer look at the many unique benefits of Yoga and Yoga therapy.

STRESS REDUCTION With the explosion in the past decade of new devices that speed the flow of infor mation, I've watched in alarm as people's stress levels have risen accordingly. From the moment we grab our coffee and begin making phone calls in the morning, to the final checking of e-mail before going to bed at night, we're barraged with a seemingly endless stream of complex challenges that we feel increasingly hard pressed to meet. As our minds speed to keep up, our bodies tense and contract in response. The result can be extraordinary levels of stress, which may at times threaten to spin out of control. Though stress levels may be higher than ever, the experience of stress is as old as humankind. In fact, it's hard wired into our DNA in what psychologists call the "fight-or-flight" response. Imagine one of our primitive ancestors coming out of a cave and confronting a saber-toothed tiger eye to eye. He would be scared to

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death. Adrenaline would start pumping into his bloodstream, his heart rate and breathing would accelerate to speed the circulation of oxygen and nutrients, his muscles would tighten, and his eyes would widen to increase his visual acuity. At this point, his body would be ready for the physical exertion of a battle or a fast run. Until he took action, his body would experience acute stress; once he responded, however, his stress would rapidly diminish, as he naturally channeled his energy into movement. Unfortunately, the challenges that most of us face today don't require, or even allow, the vigorous physical activity for which the stress response prepares us. When you are faced with a deadline, have an argument with your spouse, receive a stressful series of phone calls, or are put on the spot during a meeting, you are unable to strike back or flee. Instead, you remain frozen in place with no physical way to express anger or fear. As a result, your muscles remain tense and con tracted—unless and until you deliberately stretch them. Recently I had an opportunity to experience the fight-or-flight response first hand. Fortunately, my years of Yoga practice allowed me to defuse my stress rapidly—and neutralize a potentially inflammatory situation, as well. Kaustub Desi kachar, the son of my Yoga teacher, had come to visit with his new wife, and I was giving them a scenic tour of Los Angeles. As we were driving through the hills, a gang of bikers rode up behind us, revving their engines. They seemed annoyed that we were going the speed limit and blocking their way. Afraid of what they might do and concerned for the safety of my special passengers, I found my emotions going into overdrive, with my heart pounding and my adrenaline surging. Draw ing on my Yoga experience, I took several long deep breaths and relaxed my body as much as I could. Finally, the lead biker pulled up beside us and made an obscene gesture using one of his fingers (you can guess which one). I smiled and showed him a couple fingers of my own—the peace sign. Surprised, he hesitated for a moment, then smiled back, shook his head, and returned to his gang. With a few breaths I had reduced my stress and brought a resolution to our encounter. Even though I had been able to respond without aggression, my muscles held the physical memory of stress and tension until I could physically stretch them later with Yoga. The body holds muscle length constant the way a thermostat holds a temperature constant in a house. Muscles get set to a certain shortness and

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cannot lengthen on their own; they must be pulled by an outside force, such as a Yoga stretch. If you stretch consciously and deliberately, your brain is encouraged to reset your muscles to a new, more relaxed length. Your muscles are less likely to tear and are more efficient. Your mind—body returns to a state of balance. Many Yoga practices counter the fight-or-flight response and invite the body to move in the opposite direction toward peace and calm. Gentle stretching lengthens your muscles, reducing physical tension. Yoga breathing slows your res piration. Inverted postures can help lower your blood pressure by decreasing your heart rate, relaxing your arteries, and reducing levels of the stress hormone nora drenaline. Resting Yoga postures allow you to let go of physical and mental effort. Meditative practices help you put fear and anger into perspective. With increased calm and relaxation comes a decrease in your level of Cortisol, an adrenal hormone that inhibits immune system function. This keeps your body at optimal alert against disease.

IMPROVED

C I R C U L AT I O N

When the circulation of blood is restricted in any way, the cells of your body may not get the oxygen and nutrients they need to function effectively. As a result, your energy may plummet, your mood and mental capacities may suffer, and ultimately your overall health may be impaired. Good circulation is a prerequisite for good health. The practice of Yoga improves the flow of blood to and from the heart in a number of significant ways. Standing Yoga postures squeeze the veins in the leg and gently push blood back toward the heart, similar to other exercises, such as walk ing, that contract the leg muscles. Yoga postures that lift the legs above the heart use the force of gravity to do much the same thing. When you practice a variety of Yoga poses, you systematically position your arms, legs, trunk, and head both higher and lower than your heart, draining, then refreshing the blood supply to each area, improving the delivery of oxygen and nutrients, and removing carbon dioxide and waste products. In addition, when you practice twisting and bending postures, you compress certain muscles and organs and release them. This action squeezes the blood from the area and allows fresh

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blood to enter, much as you might squeeze and then soak a sponge. Fatigue is reduced; every part of your body receives its proper nutrient supply.

INCREASED FLEXIBILITY AND STRENGTH In almost any Yoga pose, especially the standing postures that work against gravity, you are both stretching and strengthening your muscles. For example, when you stand and bend forward from your hip joints, the pelvis tilts on the tops of the thigh bones and lengthens the hamstring muscles on the backs of your thighs, which run from your sit bones down to the backs of your knees. When you come up out of the standing forward bend, you lift up your body weight by contracting (and thereby strengthening) the same muscles you stretched on the way down. This combination of stretching and strengthening makes Yoga an especially good routine for professional athletes, who need to maximize their flexibility to avoid costly injuries. Many athletes have discovered the benefits of Yoga in recent years, including the 2000, 2001, and 2002 World Champion Los Angeles Lakers, who practiced Yoga weekly on their way to the championship. Former Laker cen ter Kareem Abdul Jabbar was a devoted practitioner of Yoga and meditated before every game to reduce stress. He set National Basketball Association (NBA) records for scoring the most points in a career, winning the greatest number of Most Valu able Player (MVP) awards, playing in the most Ail-Star games, and being the old est active player. I always wonder how much his Yoga practice contributed to his greatness.

ENHANCED

C O N C E N T R AT I O N

By demanding your singular attention to the present moment, Yoga trains you to concentrate and clear your mind of distracting thoughts and preoccupations. If you don't give your full attention while doing a physical posture, you're liable to hurt yourself. Yoga demands that you listen to the voice within, your own unique body wisdom, to go to your limit without unwisely exceeding it. Even just attempting 20

to hold a simple pose requires concentration. If you're balancing on one foot, you have to concentrate or you will fall right over. Paying close attention to your sensations in each pose tends to clear whatever else is on your mind at the moment. This is meditation. To the extent you are focused on your breath and body, you are not having thoughts about business or personal matters. That part of your mind is quiet. By the time you get to the end of your routine, your mind is focused and calm and your body, relaxed. Ultimately, the concentration acquired from the physical practice of Yoga spills over to other areas of your life. Students who practice Yoga regularly tell me that they find it much easier to become engrossed in their work and to remain undistracted for extended periods. They also report that their intimate relationships improve because they can stay present and available to partners and friends far more readily than before.

OVERALL SENSE OF WELL-BEING In 1989 I founded the corporate Yoga program at the J. Paul Getty Museum in Malibu, California. The classes were held at lunchtime in the museum's boardroom and attracted students from many levels of the corporate hierarchy. Just outside the boardroom was a guard station that most of the students passed on their way to and from class. After I had been offering the program for three months, one of the security guards working the booth gave me a memorable compliment. He said, "Since you've been teaching Yoga classes here, everyone that passes my station is so much nicer to me. They tell me they feel happier after your class." According to ancient philosophy, Yoga postures open spaces throughout the body that allow the life force (prana) to circulate more freely. Certain poses seem to create space between the vertebrae, within the joints, and around the internal organs; other poses feel like they lift the heart and open space between the neck and shoulders. Many approaches to alternative medicine maintain that disease and pain are caused, in part, by "stuck" energy. Constricted or blocked channels where nervous energy, air, or blood do not flow properly lead to trouble. By improving circulation and reducing muscle tension, most people who practice Yoga find that they gain more energy from the process. Exactly why Yoga affords most people who practice it an amplified sense of

well-being is not yet completely understood by science. We do know that Yoga has numerous benefits, both physical and psychological. In my experience with stu dents, I've found that when individuals reduce their stress, relax their muscles, and calm their mind, they report more enjoyment in simply being alive. This is important because, unfortunately, not every ailment can be healed. In some cases, the practice of Yoga works not to eliminate a disorder completely, but to minimize its physical, mental, and emotional impact. A Yoga lifestyle can help heal your heart and mind, bringing you to a state of peace and well-being. This is where the true joy of living comes from, and you can have it even if you're living with chronic illness or disability. Take a moment to imagine that you have achieved a state of optimum health and balance on every level: physical, emotional, and spiritual. Imagine those migraines dwindling, that depression lifting, that hay fever subsiding. What would your life be like? How would you feel? Certainly your stress level would diminish, and your work and relationships would improve. More important, you might even experience an inner peace and a radiant vitality that external circumstances could not easily disturb. Yoga is a powerful tool that can help you approach this state of optimum health, harmony, and well-being. We're confident that Yoga therapy can im prove your health in significant ways, whatever your present condition may hap pen to be.

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3

Getting Started with Yoga Therapy

I ome of the traditional Yoga schools in India still recommend principles and % practices that would seem quite strange and distasteful to us Westerners. On ' my first trip to India, I had the opportunity to visit a number of Yoga ther apy clinics. My first stumbling block was that Yoga therapy practice was always rec ommended at sunrise (5:30 A.M.). My next challenge came when I reported a digestive problem. I was instructed to drink ten glasses of salt water, which was fol lowed by numerous regurgitations. As unpleasant as it was, it actually did make me feel better. I was closely supervised by an expert and had plenty of time to rest after ward. However, because this could be quite dangerous, we do not recommend this therapy under any circumstances. I mention it as an illustration of how the princi ples of Yoga practice vary from culture to culture. In the West, a Yoga therapy practice has to be compatible with our culture as

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well as practical, user friendly, and safe. There are several important principles that I feel capture the essentials of an effective Yoga therapy practice for our modern world. They include the following: Commitment to a daily Yoga therapy program Combining breath with movement Emphasizing function over form Incorporating dynamic and static principles of motion Focusing on the spine Slowing down your pace Avoiding competition Staying faithful to sequencing

KEEP YOUR VOWS OF COMMITMENT This book is designed to be a do-it-yourself program. However, I want to be right up front about the fact that it takes terrific discipline to practice Yoga faith fully and regularly on your own. Knowing this, you may want to consciously commit yourself to doing some form of practice every day, even if it's only for three minutes. Choose a comfortable place and time in which you can practice consistently each day. It can be any place that gives you enough space and preferably some peace and quiet. It is okay to practice after a small meal or snack, but you need to wait two to three hours after a heavy meal. Once you have begun your daily practice, be patient and compassionate with yourself. Yoga will get easier each time you do it, and eventually you will build up the momentum for a longer practice. Realize it may take a month or more for your daily Yoga to become a habit. If you persevere even when you'd rather quit, Yoga will help you feel better each day, and pretty soon you will not feel complete without it.

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EMPOWER YOUR MOVEMENT

Chapter 4 outlines the reasons and techniques for Yoga breathing. It is essentia] that Yoga breathing accompany movement at all times. Always move slowly and keep your mind focused on the breath coupled with movement. Coordinating breath and movement supports the union of the body, breath, and mind. Focusing on breath ing helps you concentrate on what you are doing in that very moment, rather than thinking about your car payment or what you're going to have for dinner. As a basic rule, inhale when the Yoga posture opens the body, exhale when the position folds the body. For example, if you are executing a standing forward bend (which is like a toe touch), inhale as you lift your arms up, and exhale as you are folding or bending forward and down. There are four ways that your body moves naturally with the breath: Forward bend (flexion), back bend (extension), side bend (lateral flexion), and twist (rotation). lale as you are going into a forward bend, side bend, or twist. Inhale as you are coming out. Inhale as you are going into a back bend, and exhale as you are coming

EXHALE

If You are in the middle of a breath and movement cycle and you run out of breath before you

/e completed tne movement, pause your movement b

and then return back to the starting place. For example, if you are raising your arms on an inhalation and run out of breath before they are fully extended, just stop your arms where they are and lower them on the exhalation. Let the length of your breath determine how far you move into the posture. Eventually your breath will deepen, and you will be able to complete the full breath and movement cycle. Sometimes you hold or stay in a posture for several breaths. When you do, it is okay to increase the stretch on each succeeding breath.

EMPH

FUNCTION OVER

FORM

Many Yotra books illustrate a standing forward bend with the model's forehead touching her knees, her legs and arms straight, and the palms of her hands on the ground. While the form in this posture looks great, the truth is only about 10 per cent of the entire population can achieve it, and it's not necessary for a successful Yoga practice. Although some practitioners might disagree, there is no perfect Yoga posture; what matters most in Yotia therapy is the function, not the form. You should never try to torce your;

ideal posture. While maintaining good technique

don't try to push yourself too far. One of the tools you can use to achieve the func tion of the pose is a concept I call "forgiving limbs." For example, if you're trying to do a standing forward bend, your legs and back may be stiff and hamstrings tight. As you move into position and feel a pull in the back of your legs, be forgiving. Bend your knees enough to fit your needs. Soften ing your legs will bring more freedom to the lower back. Softening your arms will bring more freedom to your upper back, neck, and shoulders. As you become more flexible you can begin to straighten your legs, but do not lock or hyperextend any of your limbs. The primary function of the standing forward bend is to stretch your back, with a secondary goal of loosening up your hamstrings. This principle also applies to standing side bends and twists. You'll be amazed at how your body instinctively knows what to do. Relax, tune in, and follow your inner guide. Note that the models shown on page 25 have soft limbs.

USE THE DYNAM IC AN D TH E STATI C When we are moving in and out of postures, we are using the dynamic. When we are holding a posture, we are using the static. Yoga practice is most effective if we incorporate both the dynamic and the static into our routines. We do this by slowly moving in and out of most Yoga postures a few times before holding them. There are exceptions: in some postures we use either the dynamic or the static, but not both. Your Yoga routine as a whole will incorporate the two principles. There are distinct advantages to the combination dynamic-static approach. First, using movement before holding each posture provides a safety factor by enhancing the circulation (or blood flow) in the area and thus preparing the mus cles and joints for the holding phase. Moving in and out of postures before holding them allows for a deeper stretch. This concept is a variation of what is called pro prioceptive neuromuscular facilitation (PNF). In a nutshell, if you tighten a muscle just before you stretch it, it will stretch farther. (It's like bending your knees before jumping rather than jumping from a standing position.) This is especially true for many of the standing postures in which you are bending forward and stretching the 27

major muscles with gravity, then rising up against gravity and tightening the same muscles. For many postures, we recommend that before you hold them, you move in and out at least three times, but not more than six. Hold a posture for six to eight breaths, or roughly thirty seconds. Continue your Yoga breathing while holding. Do not hold your breath. For each Yoga posture suggested in this book, the number of repetitions and/or the holding time are specified. Follow the instructions carefully, noting that a few postures incorporate repetition without holding, and others instruct you to hold but not repeat. After practicing a while, you'll get a feel for it. Your practice may vary, depending on how you are feeling on any given day. Don't worry if your limbs tremble from time to time while holding a pose. That's a normal reaction in the beginning, until you build strength and become familiar with the routines. If the trembling begins to feel like an earthquake, then ease out of the pose gently. Though you may be tempted to bounce while holding certain Yoga posi tions—don't. Bouncing can lead to a distracted focus or even an injury. The dan ger of bouncing can be compared to hopping on a balance beam as opposed to just walking. The chances of slipping and injuring yourself are much greater. Some of the postures in this book contain specific instructions for coming out of them, because it is important that you do it a certain way. If the posture does not have these instructions, just move your body gently to the starting position for the next pose.

FOCUS ON THE SPINE There is an old saying: You are as old as your spine. Conversely, you are as young as your spine is flexible. I believe this to be true. The next time you're in a large group, observe how some people seem older than their years because they have become so stiff in the spine. The longer we are on this planet, the more opportunity gravity has to create a negative effect on our bodies, including compressing the spine. Yoga postures offer a method for decompressing the spine, creating a feeling of space between the ver tebrae, resulting in enhanced postural alignment. This can reduce stress to the mus28

culoskeletal, digestive, respiratory, and circulatory systems. It is why so many of the principles of practice support the concept of focusing on the spine. Function over form, forgiving limbs, and dynamic and static movements are all principles that yield more freedom to the spine. For best results, your Yoga movements should feel fluid, as though your joints are moving through water.

KEEP IT SLOW No matter how brief your Yoga routine may be on any given day, Yoga should never be done in a hurry. The whole idea of Yoga is to slow down and quiet the multitudinous distractions of the mind. In many parts of our lives, we are rewarded by speed of accomplishment. Yoga takes that rule and turns it upside down. The more slowly you go in Yoga, the greater your rewards will be. Do not rush through postures, and remember that resting poses are as impor tant as active ones. Warming up is as crucial as cooling down, and always remem ber the tiny pauses between each inhale and exhale. Your eyes can be open or closed during Yoga practice, but closing the eyes helps some people to slow down. Choose whichever is most comfortable for you each time you practice. Usually, standing or balancing poses require the eyes to be open, while resting and restorative poses can be enjoyed more fully with the eyes shut.

FORGET ABOUT COMPETITION Yoga is not a competition—not even with yourself. Yoga encourages you to move at your own pace and not judge yourself. I've been doing Yoga for more than twenty years, and sometimes I practice like a beginner when I'm recovering from an injury or just plain exhausted. Your physical condition is affected by so many factors that are constantly in flux: hormones, hydration, mind-set, stress, activity levels, and emotions. Every day your body will feel different, especially if you've been ill or are dealing with a chronic ailment. 29

It's easy to say and hard to do, but suspend all judgments when it comes to your Yoga performance. It's not about how difficult the posture is or how long you hold it. The beauty of your practice is that you will receive benefits, even if you're doing only conservative postures and holding them for only a short period of time. Ancient Yoga teachings say that where your mind goes, your circulation goes. Visualize the bodily area you are working on, and if you notice tension or resis tance, visualize your breath going to the area to soothe it and smooth it out. This does not mean breathe into the pain. There is no gain from pain in Yoga. Listen to your body. Stay tuned in with a dialogue, not a monologue. Your motto should be: Challenge myself, don't strain myself.

A LWAY S U S E P R O P E R SEQUENCING There is logic to the sequence of the postures in each of this book's routines. The art of sequencing involves placing the postures in a specific order to maximize the benefits. A good Yoga therapy program has an intelligent plan that takes into con sideration your ultimate goal, the safest and most efficient way to accomplish that goal, your skill level, and the amount of time allotted for practice. The routines in this book are designed with the assumption that you are new to Yoga and that you are busy and have limited time to devote to it. Each routine has a specific goal, either general conditioning or managing an ailment. Ranging in length from ten to thirty minutes, they are short enough to fit your lifestyle yet long enough to be effective. The routines are safe, proven, and always start with a transition posture that leads you gently from your hectic day into your routine with Yoga breathing. Next, a warmup prepares the body, followed by the main postures, which are selected to address the goal. Compensation postures bring your body back into neutral. Finally, breathing exercises and relaxation techniques allow you to rest before you move on to your next activity. Because Yoga therapy routines are so carefully designed to be safe and effective, it is important you do the postures in the order recommended.

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PART II Putting Yoga Therapy into Action

Now that you've read Part I, you have all the background you need to begin using your body, breath, and mind to practice Yoga therapy techniques. The next three chapters will instruct you in basic Yoga breathing, relaxation, meditation, and pos tures. They will get you acclimated to Yoga and prepare you for the ailmentspecific routines presented in Part III. So grab a towel and some comfortable clothes, and let's get to work!

4 The Wind in Your Sails,

Yoga Breathing

ast year, my friend Merry traveled cross-country to attend her father's funeral. Upon arrival, she was exhausted, emotionally distressed, and ner vous. Her hands were shaking, and she could feel her heart racing; but she was determined to deliver a eulogy at the service. Just before addressing the crowd, she went into a quiet room and practiced five minutes of a simple Yoga technique called Focused Breathing (page 39). Her hands stopped shaking and she felt her pulse returning to normal. She was centered and tranquil, able to read a tribute beautifully without her voice so much as cracking. It was a remarkable illustration of just how calming the breath can be. The breath is the most important tool in Yoga. Even when you cannot move your body—you're stuck in that big business meeting or that tiny airplane seat— you can still practice Yoga with your breath. Yoga breathing is simply using vari-

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ous techniques to breathe in a slow and focused manner, allowing you to concen trate on your breath and become more conscious of your body's rhythms. The ability to affect your body's functioning through the way you breathe is recognized in many areas of modern life. When you're angry and tempted to explode verbally, you're advised to "take a deep breath." People who are experi encing acute or chronic pain are often taught specialized breathing techniques as a way of managing their pain: Women in labor use variations on Lamaze breathing; and other pain sufferers, such as those with cancer or fibromyalgia, are taught deep breathing exercises to reduce their need for narcotics. Biofeedback has been around for decades and includes instruction in deep breathing to help control phys iological reactions that are ordinarily unconscious, such as heart rate and blood pressure. The martial arts use the breath as a means of keeping the body, mind, and emotions in control. Even athletes, such as Olympic swimmers and marathon run ners, must consciously work on their breathing techniques to improve their phys ical and mental functioning. Your body's breathing center is actually in the brainstem, where many of your autonomic functions are controlled, such as your heart rate, blood pressure, skin temperature, and digestive process. Breathing is the only autonomic function that you can control at will, kind of like a manual override. Research indicates that when you manually take control of your breathing, you are given a little bit of con trol over your other autonomic functions as well. Thus deep, measured Yoga breathing affects the respiratory system by increasing absorption of oxygen and release of carbon dioxide. It can calm a rapid heart rate and relax muscle tension. Yoga breathing also helps strengthen abdominal muscles and improve posture. Probably the two most important benefits of Yoga breathing are its effective ness in stress reduction and pain management. Since stress is an underlying factor exacerbating virtually all other health conditions, the reduction of stress through regular Yoga breathing can have a major effect on your health. Yoga breathing reduces stress by curbing the flow of adrenaline and other stress hormones. It also quiets the distractions of the mind and signals the brain to minimize perception of pain. I have witnessed literally hundreds of my clients over the years reduce or totally eliminate acute symptoms of back pain using Belly Breathing, a Yoga tech nique explained later in this chapter. The most phenomenal aspect of Yoga breath ing is that you are in control. You can send health-enhancing Yoga breathing messages to your body any time, anywhere. 34

ANATOMY I 0 I Entire textbooks have been written about the physiology of breathing; but don't worry, we're not going to go into that much detail here. To understand the Yoga approach, you need to know only a few basic things about breathing. When you think of your breath, you might immediately think of the lungs, but the lungs are actually passive organs that hitch along on the breathing ride. The real force behind breathing is the respiratory musculature, driven by the diaphragm. It has been said that the diaphragm is responsible for about 75 percent of the effort of quiet breathing. I wonder how many folks have any idea where their diaphragm is or how it works. Diaphragm literally means "partition," aptly enough, since it divides the thorax (rib cage) above from the

THE DIAPHRAGM

abdomen below. You could say that the diaphragm is the floor of the former and the roof of the latter. The lungs and heart sit right on top of the diaphragm, and the stomach and liver nestle right below it. Our diaphragm's rhythms—powered by our breathing— affect these organs, partially explaining how breathing influences so many other functions of the body.

diaphragm

The circumference of the diaphragm attaches to the lower rim of the rib cage, which makes it look in outline like a giant kidney bean. It also has two long skinny muscular attachments, called crura, along the sides of the lumbar vertebrae. They always remind me of a long pair of pigtails. Each inhale is initiated when the diaphragm contracts and descends. The dou ble dome flattens out and pushes down (only about an inch) against the abdominal contents, which have nowhere to go but out. I'm sure you have noticed how your belly puffs every time you inhale. That puffing, which allows the easy descent of the diaphragm, is made possible by the relaxation of the rectus abdominis, a mus cle that runs in a flat sheet between your pubic bone below and the bottom of the sternum above. The contraction and descent of the diaphragm (assisted by a few sidekick res piratory muscles) increases the volume of the thorax, lowering its pressure relative 35

to the outside world. Just like wind is caused by air flowing from areas of high pres sure to areas of low pressure, fresh air from the outside rushes into the thorax, and voila!—you inhale. Then on the exhale, this whole thing gets reversed. The diaphragm slowly relaxes and returns to its dome shape, egged on by the contrac tion of the rectus, which pushes back and up against the abdominal contents. This decreases the volume of the thorax and the inhaled air, now full of carbon dioxide and other waste stuff we no longer need, is forced out of the lungs. Whew! If all of this information makes you a little breathless, just remember that the diaphragm is essentially a pump. Like a piston inside a cylinder it moves up and down, sucking air in and squeezing it out of our lungs.

THE YOGA PERSPECTIVE O N B R E AT H I N G In the ancient Sanskrit language, the word for breath is the same as the word for life, prana. From the Yoga point of view, the air that we breathe contains more than just oxygen, carbon dioxide, and other gases; it contains prana, our life force, that sub stance from which all life and activity is derived. Prana enters our bodies when we are born and mysteriously leaves us when we die. In the same way that the concept of a person's soul is unlikely to be proven by modern science, so the idea of prana remains unproven. Yet modern science does acknowledge oxygen itself as the most basic of human needs, and the advanced Yoga breathing techniques called prana yama (prah-nah-YAM-a) teach us to make maximum use of our oxygen for opti mum health and vitality. The principle of a life force energy is common in various cultures; in China it is known as Chi, in Japan as Ki. Just as oxygen is stored and circulated in the blood, Yoga literature suggests that prana is stored and circulated in our bodies. Ancient Yogis practiced Yoga breath ing to maintain their prana and thereby increase their health and vitality. Whether or not you accept the concept of prana, Yoga breathing's physiology and benefits are well documented in contemporary science, with advantages ranging from decreased stress to improved mental focus to deeper relaxation.

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YOGA

B R E AT H I N G

TECHNIQUES

Think of a sailboat, cutting swiftly through a sun-glinted sea—sails unfurled, bow slightly bobbing—a beautiful sight! Its sleek design conceals the powerful frame work and the elaborate systems that all interact for smooth sailing. But without the magic ingredient—wind—these systems are useless. Similarly, without breath, all of the elaborate systems of our bodies would be useless. Just as there are different types of wind to propel a sailboat, some more desirable than others, there are different types of breathing available to us, some more healthy for our bodies than others and each having its own unique effect. When you're out on that sailboat and the wind comes in short, unpredictable gusts from a variety of directions, you'll have difficulty controlling the craft, and you're going to be tossed around. However, with a calm, steady yet persistent breeze, all systems work in effortless harmony for a pleasant ride. Yoga breathing can bring our bodies into this harmonious state of smooth sailing. The idea behind Yoga breathing is to make a change in your mental and phys ical demeanor. It modifies how you normally breathe to a slower, more conscious, focused, and complete breath. It also helps tone and strengthen your abdomen. From the Yoga point of view, the abdomen is your body's center of movement, and if the abdomen is flabby there is a greater tendency toward ill health. Most of the Yoga breathing techniques in this chapter emphasize gently drawing the belly in during exhalation to strengthen and tone those muscles. There is an old Yoga axiom, The nose was meant for breathing and the mouth was meant for eating. With few exceptions, Yoga breathing is classically taught through the nose, both on inhalation and on exhalation. There is both ageless wis dom and scientific knowledge to support this concept of nasal breathing. First, when you breathe through the nose it slows the breath down because the air is moving through two small openings instead of the one big opening in your mouth. Next, when you breathe through the nose, the air is filtered and warmed (for more on why this is healthy, see Chapter 8). In more advanced breathing techniques of pranayama, the nostrils are opened and closed using the fingertips—referred to as digital pranayama—which affects the length and quality of the breath. Keep in mind that Yoga breathing has its time and place; other forms of exercise, such as swim ming and jogging, require different kinds of breathing. 37

There are temporary conditions, such as seasonal allergies, and permanent con ditions, such as a deviated septum, that can make nasal breathing difficult. However, most people with nasal allergies or a deviated septum will be able to do Yoga breath ing with no problems. If you have difficulty with nasal breathing, consult a doctor. You may also try to choose positions that keep your body upright and try to deter mine what part of the day is best for you to do Yoga. If medical care and these suggestions do not work to improve your nasal breathing, try inhaling with your nose, exhaling with your mouth. As a last resort, go ahead and use your mouth for breathing. When practicing these breathing techniques, it's normal to feel a little light headed. Since you are breathing abnormally you could, at first, feel dizzy or a lit tle spacey. Not to worry—it's normal. If this happens to you, just rest for a few minutes. These symptoms will be replaced by a greater sense of well-being.

How to Combine Breath a n d M o v e m e n t f o r Yo g a To achieve the optimum benefits from Yoga, your movement should always be contained within a cycle of breath. You begin your breath, then begin your move ment. Complete the movement, then complete the breath. A simple bar graph illustrates the relationship of breath and movement: Breath

Movement [ Another way to consider the relationship between breath and movement is to think about your breath as a wave in the ocean, and the movement as the surfer. The surfer waits for the wave to begin, rides it, then finishes the ride before the wave ends. While practicing Yoga, you first start the wave of your breath, then begin and end your movement, then let the wave subside. 38

B A S I C Y O G A B R E AT H I N G Yo g a B r e a t h i n g Te c h n i q u e s The following techniques can be used for any of the recommended Yoga routines in this book or as separate exercises while lying or sitting. If you are using any of the breathing techniques as part of a Yoga routine from Part III, follow those instructions for the number of repetitions. If you are using a breathing technique as a separate exercise, repeat a minimum of twenty to thirty times. First we'll explore four simple Yoga breathing techniques: Focused Breathing, Belly Breathing, Belly-to-Chest Breathing, and Chest-to-Belly Breathing.

Focused Breathing The easiest way for beginners to get started with Yoga breathing is to use Focused Breathing. It will help you practice the basic elements common in the more advanced techniques. Think of focused breathing as training wheels for complete Yoga breathing. Part One 1. Sit comfortably in a chair and place your hands on your thighs. Your palms can face up or down. 2. Bring your back up nice and tall and close your eyes. 3. Observe your state of mind and natural resting breath for a few cycles. Then consciously begin to make your inhalation and exhalation longer, smoother, and deeper than normal. Take control of your breath, rather than letting it happen on its own. Breathe through your nose. 4. Let there be a natural pause at the top of the inhalation as well as after the exha lation. Notice the effect the pause has on your state of mind. The pause is to help lengthen the breath and to remind you to slow down and concentrate on

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the process of breath. This pause is an introduction to meditation, the first step toward quieting the mind. 5. Notice how your breath moves your body, especially your rib cage and shoul ders. When you inhale the body expands; when you exhale the body contracts. 6. Focus mentally on just your Yoga breathing. When your mind drifts away, bring it back to the breath. Listen to the sound your breath makes. Feel the air enter ing your nose and expanding your lungs. This is how the breath is used to con nect the body and the mind. Eventually the breath and movement become a form of meditation. When you practice focusing, you'll soon notice improved concentration and the quieting of your mind, which is one of the ultimate goals of Yoga. As your concentration improves in Yoga, it also improves in other aspects of your life. 7. After 25 rounds of Focused Breathing, gradually let your breath come back to normal and sit for a few minutes with your eyes closed. Think about your state of mind when you first started and then compare it to how you now feel. You'll be amazed at how you can shift your overall energy with just your breath. Part Two When you're familiar with Part One, begin to gently draw the belly in as you exhale. Make sure you don't strain yourself or pull the belly in too much. Some times it helps to visualize wearing a belt with a large buckle in front. During the exhalation phase gently pull the belly in away from the buckle.

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Belly Breathing Belly Breathing is often used in Yoga for relaxation and pain relief. It differs from Part Two of Focused Breathing in that it requires focus on the belly in both the inhalation and the exhalation phases. 1. Imagine that you are wearing a wide elastic band around your waist. When you inhale, expand the belly and the band in all directions—front, sides, and back. 2. During exhalation contract the abdomen. Pause after both the inhalation and the exhalation, and try to keep the chest as still as possible. 3. Repeat 20 to 30 times if you're doing the breathing exercise without move ment or as directed in your Yoga therapy routine.

Bell y-to-Ch est Breathing Belly-to-Chest Breathing is often referred to as classic or three-part breathing. It was popularized by Indian Yoga teachers who came to America in the 1960s. This technique incorporates a wave-like motion involving the belly, ribs, and chest and is great for giving your body a little oxygen lift. You can use this breathing where indicated in the Yoga therapy routines or when you feel your brain needs a jumpstart to help you focus. 1. As you inhale, expand your belly, then your ribs, and finally your chest. Pause. 2. As you exhale, release your chest and ribs, then contract your belly. Pause. 3. Repeat 20 to 30 times if you're doing the breathing exercise without move ment or as directed in your Yoea therapy routine.

^

m

M

Chest-to-Belly Breathing The ancient technique of Chest-to-Belly Breathing has been popularized in Amer ica since the 1970s by the work of T. K. V. Desikachar. Desikachar demonstrated that Chest-to-Belly Breathing is the most effective method for toning muscles along the spine, counteracting the effects of all our sitting and bending forward. It is also very energizing and can be used when you first wake up in the morning or during that afternoon energy lull. 1. As you inhale, expand the chest from the top down, continuing this movement downward into the belly, then pause. 2. As you exhale, slowly draw the belly in, focusing slightly below the navel. Your rib cage will naturally lower. Pause. 3. Repeat 20 to 30 times if you're doing the breathing exercise without move ment or as directed in your Yoga therapy routine.

Using Sound The use of sound is a special form of Yoga called Mantra Yoga. You produce sound when air leaving your lungs passes over your vocal cords causing them to vibrate. In Yoga tradition, this vibration creates a healing environment for the body and the mind. The simple sounds that are user friendly in all languages and dialects are ah, ma, and sa. They are easy to use and calming to the body and mind. When spoken dur ing an exhale, these sounds substantially lengthen the breath by narrowing the air passages and slowing the release of air from the lungs. Sound can also help you coordinate your breath and movement. Some peo ple find the Yoga requirement of focusing on the breath to be somewhat abstract. By adding the ability to focus on a sound, they sometimes find the key to success. Tom, a fifty-six-year-old school psychologist, was referred to me by his physician because of numerous stress-related symptoms. He suffered from anxiety, tension headaches, and insomnia. He was an intellectual and an introvert. As he described it, he was "not in his body." He had a difficult time understanding how to link his breath and movement, admitting he was uncoordinated. Feeling that he needed something more concrete to focus on, I suggested that he begin to use sound while doing the Yoga postures. He started with the sound of ah for all of the fold ing movements such as forward bends, side bends, and twists. It was quite a break through. His brain had finally made the connection between his breathing and his action. Soon he was comfortable using any of the three sounds—ah, ma, and sa— with his Yoga practice. With sound, he could easily coordinate his breath and movement. For the first time in his life, Tom had a physical program that he could do on his own and look forward to. The big payoff was that after three months of regular Yoga practice, all of his stress-related symptoms were gone. To try using sound, practice any of the four simple breathing techniques out lined earlier, and once you become comfortable, add one of the sounds to your exhale. This means you will be opening your mouth, so you'll be exhaling through your mouth instead of your nose. See if this helps you keep your breath slow and measured and your concentration more intense.

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A D VA N C E D Y O G A B R E AT H I N G Now we'll look at five advanced breathing techniques (pranayama in Sanskrit), popularly known as Victorious Breath, Alternate Nostril Breathing, Shining Skull Breath, Cooling Breath, and Crow's Beak. It is important to practice them only after you have become comfortable with the basic Yoga breathing techniques described earlier.

Victorious Breath Learning the Victorious Breath is traditionally one of the goals of authentic Yogic breathing. It involves producing a sound like an ocean tide or a baby's breath. It is considered a more advanced skill and can be added to any of the Yoga breathing techniques when you are ready. 1. Start seated comfortably or standing with the spine erect. 2. Open your mouth and slowly inhale; as you exhale make a sound at the back of your throat like the ocean's incoming tide or a whispering haaa. 3. Now add the sound to your inhale as well. Repeat a few times. 4. Then close your mouth, breathe through the nose on both the inhale and exhale, and make the same sound focusing on the back of your throat and the chest. Make the breath long and smooth with the normal pauses at the top of the inhale and the bottom of the exhale. It is easier to learn Victorious Breath on the exhale phase. Use this type of breathing to slow yourself down even further and to deepen your concentration.

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Alternate Nostril Breathing (ANB) was developed because Yoga masters knew what researchers have only recently proven in the lab: We don't breath evenly through both nostrils. In a cycle that lasts a few hours, each nostril becomes alter nately dominant. ANB helps create balance and harmony in your system by allow ing each nostril equal time so that while you are practicing, neither nostril is dominant. This can also help strengthen the breath of a nostril that may be chron ically weaker. There are several forms of Alternate Ncostril Breathing. The followform of ANB that can ing exercise, called Channel Cleansing, is a safe and pc easily be practiced by beginners. 1. Sit comfortably in a chair, or on the floor in a simple crossed-legged position. Bring your back up nice and tall. 2. Hold up your right fist with the palm toward you and then extend the right thumb and last two fingers. Your index and middle fingers are folded down. 3. Place your right thumb on the side of your right nostril, and the ring and lit tle fingers on the side of your left nostril. 4. Block off the right nostril and inhale freely into the left. Then block off the left nostril and exhale out of the right. Then reverse it: Inhale into the right nos tril while blocking the left, and exhale out of the left while blocking the right. 5. Repeat the cycle 10 to 12 times. In your first session practicing this technique, start with inhalations and exha lations of five to seven seconds each. Over time as you continue to practice, gradually increase the length of your breath until you reach your comfortable maximum. You can also gradually increase the length of your sessions until you reach five to ten minutes. If a Yoga routine in this book instructs you to do Alternate Nostril Breathing and you have difficulty doing it, you may substitute Belly-to-Chest Breathing or Victorious Breath.

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Shining Skull Breath The Shining Skull Breath exercise has an energizing effect and is great for the physical or mental blahs. In the beginning, this exercise may leave you feeling lightheaded, but it's a great pick-me-up when you need to be alert. During my corporate days, we all had to attend laborious meetings. If I had a hard time stay ing awake, I would excuse myself for a restroom break, do two or three sets of Shining Skull Breath and come back to the meeting wide awake. The Shining Skull Breath is not recommended just before bedtime, as it may be too stimulat ing; and it should not be used during pregnancy. The focus is on short rapid inhalations and exhalations using your nose. 1. Sit comfortably in a chair or on the floor in a simple cross-legged position. Bring your back up nice and tall and place your hands on your thighs or in your lap. 2. Take a deep inhale through your nose, then exhale quickly through your nose, strongly contracting your abdominal muscles. Rest your hands on your lower belly to feel the contraction. Let the contraction push the air out of your lungs. 3. Then just as quickly, release the contraction, and watch how the breath is auto matically drawn back into your lungs. 4. Repeat this quick contraction—release cycle 15 to 20 times in succession. Each exhalation is about one second. Go slowly at first; and then after you have practiced for a few days, pick up the pace and add ten to fifteen more cycles. You could also do two sets of cycles, with a ten- to fifteen-second rest between the sets.

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Cooling Breath A great technique for mellowing out during stressful times is the Cooling Breath. It's also effective for quieting hunger or thirst when necessary. 1. Sit in a comfortable position on the floor. Bring your back up nice and tall. Place your hands on your thighs or comfortably on your lap. 2. Curl your tongue vertically and let its tip protrude slightly from your mouth. (The ability to curl your tongue vertically, so that from the front it looks like a U, is genetic. If you can't curl your tongue, try Crow's Beak, described next.) 3. As you inhale, slightly tilt your head back while you slowly suck the air in through the funnel formed by your tongue. Then tilt your chin back down as you exhale slowly through your nose. 4. Repeat 10 to 20 times. Gradually increase to 5 to 10 minutes.

Crow's Beak The Crow's Beak is

o curl your tongue for Cool

ing Breath. This technique has the same benefits as Cooling Breath. 1. Sit in a comfortable position on the floor. Bring your back up nice and tall. Place your hands on your thighs or comfortably in your lap. 2. Pucker your lips as though you were going to suck in air through a straw. As you inhale, slightly tilt your head back while you slowly suck the air in through your puckered lips. Then tilt your chin back down as you exhale slowly through your nose. 3. Repeat 10 to 20 times. Gradually increase to 5 to 10 minutes.

5 Relaxation and Meditation

tress . . . we've mentioned it several times already, and there's a good chance it's one of the reasons you're reading this book. Stress is a major fac: tor in our need for the daily calming and healing effects of Yoga. Yoga pro vides relief from stress through each of its different expressions—postures, breathing exercises, and especially relaxation and meditation. What is the difference between relaxation and meditation? The distinction is subtle but significant. Relaxation is simpler. It usually involves relaxing the physi cal body, which can take place with an active mind, but ideally quiets the mind as well. It requires a degree of control over your mind and body, but it is not too dif ficult. Relaxation is usually something we do to feel better in the moment, like having a drink or watching TV Its effects don't extend very far beyond the actual relaxation time. Meditation is a deeper, more intense technique in which the meditator seeks 48

not only to reach a deep state of relaxation but also to quiet the mind, and main tain a higher state of being beyond the time of meditation. The process develops the deepest levels of concentration as the practitioner becomes conscious of his or her own awareness and tries to transcend it. Meditation seeks a state of enlighten ment, a freedom from the tyranny of our worries. It can be challenging to learn to reach a true state of meditation, but it provides the deepest level of physical and mental relaxation and, consequently, is the most effective for stress reduction. In this chapter we'll look first at relaxation, then at meditation, giving a few basic techniques for each. Now is the time to think about setting aside ten to fif teen minutes each day to begin practicing these skills. You won't regret it.

R E L A X AT I O N In Sanskrit, the word for relaxation is shaithilya (SHY-theel-yah), which translates to "loosening." You can think of relaxation as loosening up your tension, smooth ing out all the kinks in your physical, emotional, and mental state. There is much more to relaxation than just "doing nothing." It involves a conscious effort to release your body of any effort. Sounds paradoxical, and it is; that's why relaxation is a skill to be cultivated. When you're getting ready to begin relaxation exercises, try to be in a quiet environment where you're unlikely to be disturbed. Wear appropriate clothing to make sure you are comfortable and just the right temperature—you don't want to be too warm or too cold. In addition, don't practice on a full stomach. After a heavy meal, wait two to three hours.

49

R e l a x a t i o n Te c h n i q u e s

The Quickie Of all the relaxation techniques, the Quickie is the simplest and the fastest. Accord ing to Yoga's esoteric anatomy, the left nostril is part of the "channel of comfort," which is one of the three main energy flows in the human body. It is associated with the energy of the moon. Simply breathing deeply into the left side will often create a calming effect. 1. Sit comfortably in a chair with your back straight. 2. Bring your right elbow close to your rib cage and block the right side of your nostril with your right thumb, or use the hand position recommended for Alternate Nostril Breathing (page 45). 3. Breathe slowly and deeply through the left nostril only, for 3 to 5 minutes. Make your breath a little longer than normal, and be sure to pause after the inhale and the exhale. 4. When you're finished, bring the right hand down, let your breath come back to normal, and get up slowly.

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Stress Buster ess Buster relaxation technique is especially good for that stressful time in the afternoon at the office, or just before bed to help you go to sleep. If you are at the office, close the door to ensure privacy. Wherever you are, turn off the phone and do what you can to prevent disturbances. You will need a chair, a small towel or eye bag to cover your eyes, and one or two blankets. 1. Lie on your back on the floor with your feet up on the seat of a chair. Make sure that your legs are about hip-width apart and supported by the seat of the chair all the way to the back of your knees. 2. If your head tilts back, place a blanket under your head. Cover your eyes with a towel or eye bag. Unless the room is warm, cover your body with a blanket from neck to toes. 3. Bring your focus to your belly. Breathing through the nose as you inhale, expand the belly slowly in all directions (top, bottom, sides). Once you are comfortable with Belly Breathing (page 41), begin to gradually increase the length of your exhalation until you reach your comfortable maximum. (Inhale freely, exhale forever. mtes. When you are finished, let your breath come back to normal, and rest for at least 1 minute before getting up

H e a l i n g Tr i a n g l e s Relaxation techniques such as this one involve directing your awareness to specific parts of your body, which means you have to control your thoughts. In this way, some relaxation exercises come close to resembling meditation. 1. Sit in a chair comfortably with your back straight. 2. Take a few deep breaths and then settle in to your normal breathing through your nose. 3. Bring your focus mentally to the middle of your forehead and begin to draw a mental triangle between your forehead and the palms of both hands. See the triangle in your mind and if any part is difficult to connect (usually the bot tom), spend some time there and then try to reconnect the entire triangle. Stay for 15 breaths. Then release the triangle and breathe normally. 4. When you are comfortable with one triangle, see if you can hold the triangle in your mind and then at the same time mentally connect a second triangle using your navel and the big toes of both feet. 5. Try to hold both of the triangles for 3 to 5 minutes. Release the first triangle, then the second and breathe normally. 6. As a long-range goal, once you can hold two triangles in your mind try for a third. Mentally connect with a point of light just above your head (some times called an infinity point). See the light separating and going down the outside of your body below your feet. The third triangle surrounds the other two. The third triangle may be very large, or close to your body. When you reach the point of holding three triangles, try to continue for 5 to 20 minutes. This exercise is not easy and takes time to learn. The more you practice, the easier it will be, as in the process of building up a muscle. You may notice colors forming in the triangles, or sensations inside of the triangles—mental, emotional, or physical. Just observe. When you are ready to end the exercise, release the tri angles in the order you created them. Then let the breath come back to normal and relax for a while.

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Yoga Nidra Yoga Nidra literally means "Yoga sleep." Although there are many variations of Yoga Nidra, the most popular is used to facilitate a deep state of relaxation, which is very conducive to healing. When they are not otherwise engaged, the systems of the body are free to replenish and heal. Think of Yoga Nidra as a natural tranquilizer, leading to mental, physical, and emotional harmony. Although Yoga Nidra can be practiced anytime and anywhere, the best times are early morning and just before sleep. Yoga Nidra traditionally incorporates a positive affirmation, a visualization, and a systematic rotation of consciousness to specific parts of the body. Before practic ing the routine, consider having someone read the copy to you while you do the relaxation, or record yourself reading the instructions. (It will be difficult to relax fully if you are trying to read at the same time.) Later you will be able to do the routine from memory. An excellent source on Yoga Nidra is available by Richard Miller (see Resource Guide). 1. Preparation: Lie on your back comfortably in the Corpse pose—bring your arms across your chest and hug yourself. Now let your elbows come down to the floor, then let the forearms and the back of your hands flop down to a com fortable place with palms up. Slowly turn your head from side to side and then back to the middle. 2. Close your eyes. Take a few deep breaths through the nose and then continue normal breathing through the nose. 3. First resolve: Either mentally or verbally make a sincere statement about improving your health or your life, while continuing to breathe normally. Pause before moving on to the next mental step. (Each pause in this exercise should last about 10 seconds.) 4. Visualization: As you inhale, visualize the healing rays of the sun warming and healing your entire body or, specifically, an injured or affected area. As you exhale, visualize darkness, impurities, and ill-health leaving the body. 5. Repeat for 15 to 30 breaths. Then slowly bring your focus back to the moment.

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6. Rotation of consciousness: Bring your attention to the bottom of your feet and begin to relax your toes one at a time, beginning with the big toes on both feet, then the next toe, the next, the next, and the little toe. Pause. Release your ankles and then your knees. Mentally go inside of your knees and look around. Visualize tendons and ligaments. Imagine the kneecaps from under neath. Breathe into your knees and mentally instruct your knees to relax. Pause. Move your focus to your thighs and begin to visualize breathing into your thighs. Deeper, deeper until you reach the hamstrings underneath. Visu alize the hamstrings releasing, relaxing, letting go. Pause. Now release the hips into the floor. Just let go. Pause. Bring your focus to your lower back. Think about the connection with your lower back, the floor, and the earth. Pause. Bring that same connection to the middle and upper back. 7. Breathe into any tight spots (or visualize your prana flowing to these places). If you feel any tension, let it go. Pause. Surrender your shoulders down through the arms, down through the hands, and out through your fingertips. Pause. Release the back of your head and all of the tight spots behind the ears. Pause. Move your attention to your face, starting with the tight spot between the eyes. Now relax the muscles around your eyes, the nose, and the mouth. Release the mouth, the tongue, the spot below the tongue, just let it go. Pause. 8. (Option) You can repeat the rotation sequence (Steps 6 and 7) 1 to 3 more times, depending on the time you have available and how deeply you want to 9. Remember the feeling: Take a few moments to think about how you're feeling right now, in your body and in your mind. Try to hold this feeling so that you will remember it later. Wiggle your toes and fingers, open the eyes a little, then a little more. Bring your arms overhead and stretch out. Roll to one side and stay there for a while. When you come up, let your head be the last thing to rise up. Use your hands, arms, and forearms to push up into a sitting position, and then relax until vou are ready for vour next activity.

M E D I TAT I O N If someone offered you a quick do-it-yourself drug-free way to lower stress and reduce pain, would you be interested? With stress and pain under control, many people report improved memory, concentration, creativity, and productivity. These may sound like the some of the same benefits of Yoga you've already read about in this book. But meditation offers these advantages without requiring exer cise. Great results can be achieved in only ten to twenty minutes of meditation a day or several sessions a week. Meditation does not require any special props, equipment, or clothing, plus—like Yoga breathing and relaxation—once the skill is acquired, you can take it with you anywhere. Is meditation a required part of your Yoga practice? Not necessarily, but if you're reading this book, you probably have health concerns; and like the Yoga breathing discussed in Chapter 4 and the relaxation exercises presented in this chapter, meditation is just one more powerful tool for restoring your body to opti mum health. Meditating brings you into a deep state of calm, soothing the central nervous system and releasing the mind from worries. This encourages your systems to work at their full capacities to help your body heal itself. By now you're catching on to the possible benefits of meditation, but now we must direct your attention to the fine print: There's nothing easy about it. If you aren't accustomed to sitting quietly and doing absolutely nothing except being with yourself, even a short meditation can seem as tough as a climb up Mount Everest. You will probably encounter the gremlins, the ones that make your nose itch, your back ache, your brain race, and your foot fall asleep—all the little things that will drive you to distraction. Like any worthy endeavor, meditation requires commit ment, patience, and a healthy measure of perseverance. After ten years of learning and teaching Yoga, I asked a great meditation teacher to help me develop a deeper meditation practice. I decided to focus on meditating during one of my annual trips to the garden island of Kauai. My teacher's most important bit of advice was simple: No matter how distracted the mind is, be patient and sit three times a day, beginning with five minutes and work ing toward a goal of thirty minutes at a time. On the first morning, I plunged in, telling myself, "I am going to sit here for half an hour if it kills me." Well, it almost did! I couldn't believe how difficult it was 55

to sit quietly for even five minutes. My mind was going everywhere, a common circumstance that I later learned is called "monkey mind." But I remembered my teacher's advice. As challenging as it was, I sat there and focused on my breathing. By the third day, I was learning to be more patient. I set smaller goals, and soon I was able to sit with a relatively quiet mind for five whole minutes. As I increased my goal in tiny increments, I found I was able to sit quietly for longer each session. When we approach our goals this way, things that might have seemed unthinkable become real possibilities. A meditative state is often compared to a tranquil body of water, such as a placid lake or pond. What is less often said, however, is that once tranquility is achieved, it doesn't necessarily guarantee that only calm or positive feelings come to the surface. To extend the lake analogy, there may very well be debris at the bot tom that floats up in the form of negative thoughts or feelings, perhaps anger, resentment, or discontent. When you first try meditation, you might also feel bored, sleepy, or a general discomfort. This is a common response; try to acknowl edge those thoughts and feelings without judging them. It's all part of the journey leading us to the ultimate goal of meditation: to quiet our minds enough to hear our inner voice, seek true wisdom, and experience our deepest intuition. Along the way to these somewhat lofty ideals, remember that simple meditation and relaxation techniques are among the best ways to manage stress.

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M e d i t a t i o n Te c h n i q u e s Meditation can take years to master, but you don't have to be an expert to reap rewards. You will see benefits even if you never progress past these three basic meditation techniques: Focused, Open-Ended, and Mantra.

Focused Meditation Focused Meditation is a technique in which you direct your awareness onto some thing. It could be an object like a picture or statue of a deity; a universal principle such as compassion or forgiveness; or a symbol such as om, the famous Hindu mantra. You can try Focused Meditation right now. Just be aware that this elementary exercise isn't as easy as it seems, so be patient and compassionate with yourself. One of the favorite objects of meditation is your own breath. It's certainly con venient, and the Yogis maintain it's a direct channel to your authentic self. 1. Sit comfortably, close your eyes, and begin to focus on your inhalation and your exhalation. 2. As you inhale through your nose, count to yourself, "One." Exhale. Then, on the next inhale, count, "Two," And so on. After each inhalation, try to hold your breath for one short beat before the exhalation. That short, quiet pause may serve as a doorway into meditation because at that point you are close to stillness. How high can you count before you lose track of the count completely? Be honest with yourself. Don't be shocked if you forget the count fairly quickly. Just go back to square one and start again. Keep trying until you can count straight through to ten, and if you get to ten, go back and count to ten again. Notice what happens to your breath as you focus on it for increasingly longer counts, and what effect this has on your awareness. Strengthening your ability to focus is just like strengthening a muscle. The more you exercise your awareness, the stronger it gets.

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Open-Ended Meditation Open-Ended Meditation is a technique in which there's no particular object of meditation. The meditator just opens up to his or her own inner experience and simply observes whatever arises, without identifying with or judging that experi ence. Again, it's not hard to begin this kind of meditation, though at first it is diffi cult to stay with it for more than a minute or so. 1. Sit comfortably and close your eyes. Bring your awareness to your thoughts, feelings, fantasies, desires, memories—whatever comes up for you. Don't get attached to what comes up, and don't try to direct it, just be an observer and witness to it all. 2. As you progress and are able to hang on to this open-ended awareness for longer periods of time, notice what happens to the usual flood of contents that continually swirls around inside your head. Practice this until you feel com fortable maintaining it for at least 5 minutes.

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Mantra Meditation In Sanskrit, the man in mantra means "to think," and the tra suggests "instrumen tality." Mantra literally means an "instrument of thought." The whole idea with mantra meditation is to repeat a word, phrase, or sound to transcend the constant distractions of the mind. The continuous repetition of a mantra is called japa. The concept of mantra can be found in many spiritual traditions, including Christianity, Hinduism, Buddhism, and Judaism. Millions of Americans were introduced to Mantra Yoga in the 1960s through the Transcendental Meditation (TM) move ment founded by Maharishi Mahesh Yogi of India. 1. To begin, choose a word, phrase, or a short sentence from a prayer or poem that inspires you. For example, you could choose the sentence, "Thou art with me," from Psalm 23. Limit your mantra to three or four words at the most. 2. Sit quietly in a chair with your back up straight. Close your eyes or half close them, gazing downward. Take a few deep breaths through the nose. 3. When you're ready, say the mantra you have chosen during your exhale. Con tinue to inhale through your nose, and repeat your mantra out loud on each exhalation, for 5 to 10 minutes. You will have more success with your concentration if you can hear yourself verbalizing your mantra. After you've been practicing for some time, you may want to begin reciting the mantra very softly or even silently, as this is said to be the most powerful form of mantra meditation. Once you feel comfortable with the silent recitation, begin repeating the mantra mentally with your thoughts dur ing both the inhale and the exhale. You can use this form of meditation for up to thirty minutes.

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6 Core Yoga Routines That

Really Heal

re you ready to do some Yoga? Now that you've become familiar with Yoga breathing, relaxation, and meditation, it's time to learn some basic postures and do your first Yoga routine. There is no single posture or Yoga routine that is right for everyone. Yoga therapy is based on adapting a program to fit the needs of the individual. However, there are basic principles and safe routines commonly used for general condition ing and for treatment of selected health conditions. The two Yoga routines in this chapter are designed to help your body heal itself. Core Routine I is designed to help beginners bring the body into balance with strength and flexibility, and Core Routine II is a bit more advanced and helps build stamina. They are a gentle intro duction to Yoga and a great place for you to start if you're ready for general condi tioning. If Core Routine I seems a bit difficult, start with the Lower Back Routine (page 114), which is even more gentle and helps balance your body. If you have 60

a specific ailment that is addressed in Part III, please do the routine recommended in that chapter. I hope that you've read Chapters 1 through 5 already, but it is particularly important that you read Chapter 3 on getting started, and Chapter 4 on Yoga Breathing before trying any of these routines. Photographs of Yoga postures are shown in the modified form with forgiving limbs—feet placed at hip width, legs and arms slightly bent. This is inspired by the Viniyoga tradition, which seeks to adapt the Yoga postures to fit the needs of the person, and ensures that you will be safe and kind to your body while learning Yoga techniques. As mentioned in Chapter 3, these postures may look different from the classic Yoga poses you have seen, which in many cases are too extreme for the average Yoga practitioner.

CORE ROUTINE I You should use Focused Breathing (page 39) for the whole routine. Move slowly, and remember the brief pauses after the inhale and the exhale. Caution: If any of the postures cause pain or do not feel right, simply leave them out and check with your health-care professional before continuing.

Mountain Posture The Mountain Posture is the cornerstone for all standing postures, and you will be using it throughout this routine. It improves posture and spinal alignment, creating l breathing. stability in your stance and fr 1. Stand with your feet at hip width. Keep your spine tall but relaxed. Let your arms hang at your sides, palms turned inward 2. Align the middle of your ear, your shoulder, and the sides of your hip, knee, and ankle along an imaginary vertical line. 3. Look straight ahead. 4. Remain in this posture for 8 to 10 breaths.

Standing Forward Bend This posture stretches the entire backside of your body, including your neck, shoulders, back, and hamstrings. It promotes circulation to your upper trunk and head, and adds flexibility to your spine. Caution: If you have been diagnosed with a spinal problem (such as a herniated disk), acute hypertension, or glaucoma, be careful of all standing forward bends. Avoid this posture if it causes you any pain. 1. Begin in the Mountain Posture. As you inhale, raise your arms from the front, up and overhead. 2. As you exhale, bend forward from your hips, bringing your arms, hands, torso, and head forward and down toward the floor. When you feel a pull in the back of your legs, soften your knees and hang your arms. 3. As you inhale, choose one of three ways to come up, listed here in order of increasing difficulty. a. Roll up like a rag doll, stacking the vertebrae one at a time, and then raise your arms forward and up as in Step 1. b. Sweep your arms up from the sides like wings until your arms are overhead and your head and torso are straight c. Bring your arms and hands forward and up alongside your ears and then bring your arms, head, and torso up as in Step 1. 4. Repeat 3 times, and then hold Step 2 for 6 to 8 breaths. Come up a final time.

Warrior I This lunge-like posture strengthens your legs, back, shoulders, and arms. It helps improve stamina and balance and increases flexibility in your hips. 1. Start in the Mountain Posture. Take a big step forward with your right foot, approximately 3 feet for taller people, less if you are shorter. Your right knee should be directly over your ankle, and your thigh should be parallel to the floor. Place your hands on your hips and square your hips forward. Keep both legs straight and hang your arms at your sides in the ready position. 2. As you inhale, raise your arms forward and up overhead, and at the same time bend your right knee to a right angle. You should feel like you're in a classic runner's stretch, with a light pull in your left calf. 3. As you exhale, straighten your right leg and bring your arms back to the ready position as in Step 1. 4. Repeat 3 times, then hold Step 2 for 6 to 8 breaths. Straighten up. 5. Repeat on the left side

ding Asymmetrical Forward Bend This posture stretches each side of your hips, hamstrings, and back. 1. Start in the Mountain Posture. Take a big step forward with your right foot, approximately 3 feet for taller peo ple, less if you are shorter. Place your hands on your hips and rotate your torso toward the right, squaring your hips forward. Bend your right knee but keep your torso straight up. Check your stance. Make sure your knee is above your ankle so that your shin lcular to the floor, your thigh parallel, and your knee at a right angle. Finally, straighten both legs, and hang your arms at your sides in the ready position. 2. As you inhale, raise your arms, stretching them forward and up alongside your ears. 3. As you exhale, bend from your hips, forward and down, over your front leg. Soften your front leg to fit your needs. If your head is not close to your right leg, bend your right knee more. If you have the flexibility, straighten your right leg, pull your right hip back and your left hip forward. 4. On the inhalation, choose one of three ways to come up: a. Roll up like a rag doll, stacking your vertebrae one at a time, and then raise your arms forward and up as in Step 2. b. Sweep your arms up from the sides like wings until your arms are over head and your head and torso are straight up as in Step 2. c. Bring your arms and hands forward and up alongside of your ears and then bring your arms, head, and torso up as in Step 2. ^. Repeat Steps 3 and 4, three times. The last time, stay in the folded position for 6 to 8 breaths, then roll up as described in Step 4a. 6. Return to the Mountain Posture, and repeat on the left side.

Revolved Triangle This gentle twisting posture stimulates circulation to your spine, opens your hips, and stretches your hamstrings and calves. It also strengthens your neck, shoulders, and arms. 1. Start in the Mountain Posture. Exhaling, step out to the right in a wide stance, x proximately 3 feet for taller people, less if you are shorter, still facing forward. 2. As you inhale, raise your arms out to the sides, parallel to the floor forming a T. 3. Exhaling, bend forward from your hips; then, in a twisting motion, place your right palm or fingers on the floor near the inside of your left foot. Continue exhaling. Raise your left arm into a vertical position and look up at your left hand. To make the posture easier, soften your left knee and arms, or move your right hand back to the right, below the midline of your torso. To make the posture more challenging, straighten your leg and place your right hand just outside of your left foot. Return to the upright position. 4. Repeat 3 times, and then hold Step 3 for 6 to 8 breaths, peat the same sequence on the other side. When finished, return to the Mountain Posture.

Standing Spread-Leg Forward Bend This forward bend stimulates circulation to your upper torso and head. It opens your hips and stretches the backs and insides of your legs, including your ham strings and adductors. 1. Start in the Mountain Posture. Step out to the right with your right foot in a wide stance, approximately 3 feet for taller people, less if you are shorter. As you inhale, raise your arms out from the sides forming a T with your torso. 2. As you exhale, bend forward from the hips and hang down, holding each of your bent elbows with the opposite side hand. Soften your knees to where you are comfortable. 3. Stay in the the Mountain Posture.

6 to 8 breaths. Roll your body up and return to

The Willow This side-bending posture stretches the lateral muscles of your trunk and laterally flexes your spine. 1. Start in the Mountain Posture. As you inhale, rotate your palms out to the sides and bring your arms up and overhead. Touch your palms together with your arms alongside your ears. Keep your shoulders dropped. You should feel your shoulder blades pressing in toward each other. 2. As you inhale, stretch your spine and arms upward. 3. As you exhale, soften your knees and bend your upper torso, arms, and head to the right. Soften your knees more to make the posture easier or straighten your knees to make it more challenging. 4. As you inhale, return to the vertical position. As you exhale again, repeat to the left side. 5. Alternate each side 3 times, then stay on each side for 6 to 8 breaths. Return to the vertical position.

>**,'

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Standing Forward Bend Repeating the posture deepens the stretch on the entire backside of your body, including your neck, shoulders, back, and hamstrings. Caution: If you have been diagnosed with a spinal problem (such as a herniated disk), acute hypertension, or glaucoma be careful of all standing forward bends. Avoid this posture if it causes you any pain. 1. Begin in the Mountain Posture. As you inhale, raise your arms from the front, up and overhead. 2. As you exhale, bend forward from your hips, bringing your arms, hands, torso, and head forward and down toward the floor. When you feel a pull in the back of your legs, soften your knees and hang your arms. 3. As you inhale, choose one of three ways to come up: a. Roll up like a rag doll, stacking the vertebrae one at a time, and then raise your arms forward and up as in Step 1. b. Sweep your arms up from the sides like wings until your arms are overhead and your head and torso are straight up as in Step 1. c. Bring your arms and hands forward and up alongside your ears and then bring your arms, head, and torso up as in Step 1. 4. Repeat 3 times, and then hold Step 2 for 6 to 8 breaths. Come up a final time.

The Tree This posture improves focus, concentration, balance, and stability. It increases the flexibility of your hips and groin, and strengthens your legs. 1. Stand in the Mountain Posture. As you exhale, place the sole of your left foot on the inside of your right leg above your knee, toes pointing toward the ground. 2. As you inhale, bring your arms out from your sides to form a T, and then, as you exhale, bring your hands together in prayer position with your thumbs touching your breast bone and fingers toward the ceiling. As a variation, bring your arms overhead and join your palms together. Look at a spot on the floor 6 to 8 feet in front of you. 3. Stay for 6 to 8 breaths and then repeat on the other side.

The Corpse This is the classic posture for relaxation of your body and mind. It can also be used for deep relaxation and treatment for hypertension. 1. Lie flat on your back with your arms relaxed near your

is turned

p. Close your eyes and relax. If your head tilts back or your neck is uncomfor Drtable, table, place a small pillow or blanket under your head and neck. If your lower back is uncomfortable, place a pillow or rolled blanket under your knees. 2. Stay in the position for 8 to 10 breaths.

Note: This is the halfway point of the routine. If you have only fifteen minutes, you can stop here.

Abdominal Flow This is a good strengthener for your lower abs and lower back. 1. Lie on your back with your knees bent, feet flat on the floor at hip width. Interlace your fingers behind your head with your elbows wide and open. 2. As you inhale, raise your hips off the floor as high as you feel comfortable, stretching your back muscles. 3. As you exhale, bring your hips down and then fold your body by bringing your chest, head, and knees toward each other, curling your chin into your chest. Keep your eyes focused on your knees. Try to keep your elbows wide. 4. Repeat Steps 1 to 3 slowly, 6 to 8 times.

C o b r a ( K i t e Va r i a t i o n ) The Cobra increases the flexibility and strength of your arms, chest, shoulders, and back. It also opens your chest and increases lung capacity. 1. Lie on your belly, with your forehead on the floor, legs slightly ap; tops of your feet on the floor. Relax your arms at your sides, palms up. If you have lower back problems, separate your legs wider than your hips, and turn your heels out and toes in. 2. Inhaling, raise your chest, engaging your back muscles. Sweep your arms from the sides like wings until you reach a T position in line with your shoulders. 3. Exhaling, lower your torso, head, and arms back to the floor as in Step 1.

Child's Posture This is a gentle stretch for your lower back, helping it relax and loosen up any ten sion. It is often used as a compensation posture after back bends or back stretches, which is how we're using it here. 1. Start on your hands and knees with the heels of your hands directly below your shoulders and your knees at hip width. Look down slightly. 2. As you exhale, sit back on your heels. Relax in the posture, and try to rest your torso on your thighs and your forehead on the floor. Do not force yourself beyond your comfort zone. 3. Rest your arms at your sides, 4. Stay for 6 to 8 breaths.

up. Close your eyes. Breathe easily.

Hamstring Stretch This stretch feels great on your hamstrings and prepares your body for numerous sitting, kneeling, and standing postures. 1. Lie on your back with your knees bent, feet on the floor at hip width. Slide your right leg all the way down, and relax your arms at your sides, palms down. 2. As you exhale, bring your right leg up to a comfortable height. (Draw your belly in as you are exhaling to make more room for your right leg to come up.) 3. As you inhale, bring your leg back down. 4. Repeat 3 times. On the last leg raise, clasp the back of your right thigh just below your knee with both hands interlaced, hold for 6 to 8 breaths. Lower your leg. 5. Repeat on the left side. Do not force it. Your leg does not need to be fully extended in the beginning. Keep your head and the top of your hips on the floor. Place a pillow or blanket under your head if it tilts back.

Caution: If you have a problem with an intervertebral disk, be especially careful of all straight-leg, seated forward bends. Try modifying by bending your knees and keeping your back extended and chest lifted. Avoid rounding your back. If it hurts, do not do this posture. 1. Sit on the floor, with your legs extended in front of you at hip width. Place your hands, palms down, on the floor near your thighs. Lift your chest and bring your back up nice and tall, as if a string attached to the top of your head 2. As you inhale, raise your arms from the front, up and overhead until they are parallel with your ears. Keep your arms and legs soft and slightly bent. 3. As you exhale, bend forward from your hips. Extend your hands, chest, and head toward your legs. Place your hands on your legs, feet, or the floor. If your head is not close to your knees, soften your knees until you feel your back stretching. To make the posture more challenging, bring your chest forward toward your feet, extending your back and straightening your legs more. As you inhale, raise your arms, head, and torso until you are in the upright posi tion as in Step 2. 4. Repeat 3 times, then stay folded (as in Step 3) for 6 to 8 breaths.

s simple twisting motion stretches and strengthens your abs and promote: healthy digestion. 1. Sit flat on the floor, with your legs extended in front of you at hip width. Bend your right knee and place the right foot on the floor with the heel near your groin, parallel to and 4 to 6 inches from your left thigh. 2. Place your right palm on the floor behind you, near your tailbone. Turn your fingers away from your hips. Bend your left arm and place your left elbow out side of your right knee with your fingers pointing up. 3. As you inhale, lift your chest and head, bringing your back up nice and tall. As you exhale, rotate your shoulders and upper back to the right. 4. Repeat for 3 breaths, gradually increasing the twist. Then stay in your com fortable maximum twist for 6 to 8 breaths. 5. Return to the upright position with your legs extended in front of you, then repeat on the left side.

This posture relieves stiffness, misalignment, and discomfort in your lower back. It releases abdominal gas and relieves menstrual cramps. We are using it to compen sate for the twisting of your back in the previous posture. (Note that the Knees to Chest is different from the Knee to Chest, which appears elsewhere in the book.) 1. Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees. 2. As you exhale, draw your knees toward your chest. As you inhale, move your knees a few inches away from your chest, rolling your hips to the floor. 3. Repeat 3 times, and then stay in the most folded position for 6 to 8 breaths. 4. Return your feet to the floor, then straighten your legs and relax in the Corpse posture.

E Relaxation Technique Remain in the Corpse Posture. Choose one of the relaxation techniques from Chapter 5 and do it for at least 3 to 5 minute:

CORE ROUTINE II Use Chest-to-Belly Breathing (page 42) or Belly-to-Chest Breathing (page 41) for the whole routine. Move slowly and remember the brief pauses after the inhale and the exhale. Caution: If any of the postures cause pain or do not feel right, simply leave them out. Check with your health-care professional before continuing.

Mountain Posture The Mountain Posture is the cornerstone for all

stures, and you will be

using it throughout this routine. It improves post stability in your stance and facilitating breathing. 1. Stand with your feet at hip width. Keep your spine tall but relaxed. Let your arms hang at your sides, palms turned inward 2. Align the middle of your ear, your shoulder, and the sides of your hip, knee, and ankle along an imaginary vertical line. 3. Look straight ahead. 4. Remain in this posture for 8 to 10 breaths.

Sun Salutation The Sun Salutation is a sequence of postures that stretches and supports your spine and improves posture and coordination. 1. Start at the front of your mat or space in the Mountain Posture. Place your palms together in the prayer position with the back of your thumbs touching your sternum in the middle of your chest with your fingers point ing up. 2. As you inhale, extend your hands and arms forward, then up overhead (upward salute). Look at the ceiling and arch your back gently. 3. As you exhale, bend forward from your hips, soften your knees (forgiving limbs), and place your fingers or hands on the floor. Bring your head as close as possible to your legs. 4. As you inhale, step your right foot back into a lunge and bend your left knee. Your left knee should be directly over your ankle (at a right angle) and your thigh should be parallel to the floor. Gaze straight ahead. 5. As you exhale, bring your left foot back even with the right and hold a push up position. If your arms are not strong enough, you can rest briefly on your hands and knees. 6. Inhale, and then as you exhale, bring your knees, chest, and chin to the floor, leaving your buttocks raised. 7. Inhaling, slide your chest forward along the floor, and then arch back into the Cobra posture. Keep your shoulders dropped and elbows in. 8. Exhaling, turn your toes under, lift your hips up, extend your legs as much as possible, and bring your chest down. Keep both palms on the floor. Your head should be in alignment with your arms. Look behind you at your feet. 9. As you inhale, bring your right foot forward between your hands and gaze straight ahead. Your shin should be at a right angle to the floor. 10. As you exhale, bring your left foot forward, even with your right. Soften your knees and fold into a standing forward bend, as in Step 3.

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11. As you inhale, raise your arms in either of the following positions. Then arch back and look up, as in Step 2. a. Forward and up overhead from the front. b. Out and up from the sides like wings. 12. As you exhale, bring your hands back to the prayer position, as in Step 1. 13. Repeat the entire sequence for 3 to 10 rounds. First lead with your right foot, and then with your left foot, alternating for an equal number of times (each side counts as half a round). To make the sequence more challenging, execute three to six full rounds and then during the normal cycle, hold for six to eight extra breaths in Steps 2, 3, 4, 5, 7, 8, and 9. Move slowly, pausing after the inhalation and the exhalation. If you have minor back problems that are aggravated by lifting up from the for ward bend in Step 11, try rolling your torso up. Keep your chin on your chest as you roll up, stacking your vertebrae one at a time, while your arms hang at your sides. Once you are fully upright, bring your arms up and overhead from the front or the sides, arch back just a little, and look up. (If your back isn't bothering you, don't use this variation, since it doesn't work your back as thoroughly.)

Revolved Triangle The Revolved Triangle is gres great tor strengthening your neck and stretching out your back and hamstrings. 1. Start in the Mountain Posture. Exhaling, step out to the right in a wide stance, approximately 3 feet for taller people, less if you are shorter. 2. As you inhale, raise your arms out to the sides, parallel to the floor, forming a T 3. Exhaling, bend forward from your hips and then in a twisting motion, place your right palm or fingers on the floor near the inside of your left foot. 4. Continuing to exhale, raise your left arm into a vertical position and look up at your left hand. To make the posture easier, soften your knees and arms or bend your left knee and move your right hand closer to the middle of your torso on the floor. To make the posture more challenging, straighten your legs and place your ri~u : outside of your left foot. Then stay in 6. Repeat the same sequence on the left side. When finished, return to the Mountain Posture.

Standing Spread-Leg Forward Bend II This forward bend stretches the back of your body, especially your spine and legs. It is also good for stretching your neck muscles. 1. Start in the Mountain Posture. Exhaling, step out to the right with your right foot in a wide stance, 3 to 4 feet, depending on your size. Clasp your hands behind your back and interlace your fingers with your palms together. 2. As you inhale, lift your chest and pull your shoulders and arms back. 3. As you exhale, bend forward from your hips and bring your arms over your head as far as they want to go. Be careful not to force this posture. 4. Roll up, leading with your chest. Repeat 3 times. Then hold the forward posi tion for 6 to 8 breaths, keeping your hands together behind your back.

Warrior III This posture strengthens your legs, back, shoulders, and arms, building stamina. It opens your hips and chest, and improves balance. It is called the Warrior in refer ence to its Sanskrit namesake, a famous warrior. 1. Start in the Mountain Posture. As you inhale, raise your arms from the front, up and overhead alongside your ears. 2. As you exhale, begin to slide the left foot back, bringing your heel off the floor. Bend forward from your hips with your arms extended forward, and lift your back foot off the floor until your torso, arms, and back leg are parallel with the floor. Your arms and ears should stay in alignment, and you should feel your weight balancing on your front foot. Pick a spot on the floor to focus on 6 to 8 feet in front of you. 3. Hold this position for 6 to 8 breaths; then return to upright in the Mountain Posture. 4. Repeat, pushing the other leg back. In the beginning, stop bending forward at any point you are unable to keep your balance. Gradually, move closer and closer to the parallel position.

Th e Boat This posture is excellent for improving balai 1. Sit with your legs fully extended in front of you. Place your hands on the floor behind you at a comfortable distance, with your fingers pointing toward your hips and with your arms straight. Lean your torso slightly back and lift your chest but keep your shoulders down. 2. As you exhale, raise your right leg as high as comfortable, without losing the lift in your chest. Then bring both arms and hands forward until they are stretched out in front of you, parallel to each other and the floor. 3. When you're ready, bring your left leg up beside the right, or you can lower the right before lifting the left. To make the posture more challenging, lift your legs (or leg) to a level slightly above your head. Stay for 6 to 8 breaths, either with both legs up or with one leg at a time. 4. Return to the starting position and rest with your legs extended for about 20 seconds. If you can, repeat once.

re f Va r iatio n This posture stretches your torso, strengthens your thighs, and feels great when you've been working your abs. It is also a preparation for the Half Shoulder Stand that follows. 1. Lie on your back with your knees bent, feet on the floor at hip width. Place your arms near your sides with your palms down. 2. As you inhale, raise your hips to a comfortable height, trying to make your body a straight line from your knees to your neck. At the same time, raise your arms off the floor and bring them toward your head, without bending at the elbow. Continue the motion of your arms until your hands reach the floor behind your head, or until you need to stop. 3. As you exhale, bring your hips and arms down and return to the starting position. 4. Repeat slowly 6 to 8 times.

Half

Shoulder

Stand

Shoulder stands stimulate circulation to your head and neck and have a rejuvenat ing effect. Caution: Do not use the Half Shoulder Stand if you have high blood pressure, heart disease, hiatal hernia, glaucoma, or neck problems; do not do this if you are moderately overweight or are pregnant. 1. Lie comfortably on your back, with your knees bent, feet flat on the floor, at hip width. Place your arms near your sides, palms down. 2. Exhaling, push your palms down firmly, bring your bent knees in and up,

feet off the floor,

straightening your legs as you raise your hips. Lift your hips off the floor as high as you comfortably can. 3. Continue exhaling and bend your elbows. Bring your hands to meet the top of your hips, then slide them up to your lower back. Use your elbows and the backs of your upper arms against the floor for support. Keep your legs straight but not locked, with your feet directly above your head. Try to relax your neck. Your weight will be distributed between your shoul ders and your elbows, and you may have a sensation of blood flowing into your face or head. 4. When you feel ready to come down, lower your hips to the floor with the support of your hands, and then bend your knees and lower both feet to the floor. 5. Remain in the uplifted position for as long as you feel comfortable or up to 5 minutes. For a similar effect with less difficulty, use the sup ported Half Shoulder Stand, described next.

Half Shoulder Stand (Supported) ubstitute

for

Half

Shoulder

Stand

This posture has the same benefits as the Half Shoulder Stand, but it uses props to make it a little easier. 1. Place a bolster or several folded blankets parallel to and about 6 inches away from a wall. 2. Sit sideways on the support, and then swing your legs up the wall. Rest the back of your pelvis on the support, and rest your head, neck, and shoulders on the floor. 3. Move your buttocks toward the wall until your sit bones are relaxed in the space between the support and the wall. If you like, cover your eyes with a towel or eye bag. 4. Remain in this position for 3 to 5 minutes. When you are ready to come down, bring your knees toward your chest and slowly roll to one side. 5. Recover in the Corpse posture.

This posture is good for general strengthening and overall stamina. Caution: If this posture causes pain in your back or neck, leave it out. 1. Lie on your belly, with your head turned to the right, legs slightly apart with the tops of your feet on the floor. 2. Cross your hands behind your back, with your palms up, resting on your tail3. Inhaling, raise your chest, sweep your right arm and hand forward and up, lift your left leg as high as possible, and bring your head to the middle so you are facing front. 4. Exhaling, lower your torso and leg back to the floor as you sweep your arm and hand back to your tailbone and turn your head to the left. 5. Repeat on the other side. Alternate each side 4 to 6 times. 6. To make the sequence more challenging, stay in the raised position for 4 to 6 breaths on each side after alternating 3 times on each side.

Prone Resting Posture to compensate for the strenuous Locust that preceded it 1. Lie flat on your belly. Make a pillow with your arms and hands by bending your elbows and placing your forearms on the floor and placing your hands inward, one hand on top of the other. Turn your head to one side and rest your head on the back of your hands. 2. Stay in this position for 6 to 8 breaths.

Sitting Cat This is a very nurturing and restful posture, reminiscent of our body positioning in the womb. (If you have knee or hip problems, replace Sitting Cat with Knees to Chest, described on page 93. Thus you will be doing Knees to Chest twice in this routine.) 1. Start on your hands and knees, looking slightly down, with the heels of your hands directly below your shoulders and your knees at hip width. 2. As you exhale, sit back on your heels and bring your head toward the floor. Work toward resting your torso on your thighs with your forehead on the floor, but do not force it. Sit back only as far as comfortable. 3. Repeat 3 times, and then relax with your head down and your arms in front (as in Step 2), for 6 to 8 breaths.

in g Bent-Leg Tw i s t This is a relaxing stretch of your abs, lower back, chest, shoulders, and upper arms. 1. Lie flat on your back with your legs straight. Place your arms in a T, aligned with the tops of your shoulders, palms down. 2. Bend your right knee, bring your right foot up and place it on top of your left thigh just above the knee. Place your left hand on top of your right knee. 3. As you exhale, slowly use your left hand to press your right knee to the left toward the floor. Go as far as you can without straining. Simultaneously, turn your head to the right. You should feel the pull in your right hip. 4. Bring your right knee back upright. Lower your right knee back down to the left 3 more times. On the last time, hold the lower position for 6 to 8 breaths. 5. Return to the starting position with your legs straight. 6. Repeat the sequence with the left leg.

Knees to Chest This posture relieves stiffness, misalignment, and discomfort in your lower back. We are using it to compensate for the twisting of your back in the previous pos ture. (Note that the Knees to Chest is different from the Knee to Chest, which appears elsewhere in the book.) 1. Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees. 2. As you exhale, draw your knees toward your chest. As you inhale, move your knees a few inches away from your chest, rolling your hips to the floor. 3. Repeat 3 times, and then stay in the most folded position for 6 to 8 breaths. 4. Remain in the Corpse position.

Relaxation Technique Remain in the Corpse position. Choose one of the relaxation techniques from Chapter 5 and do it for 3 to 5 minutes.

PART III Yoga Therapy for Common Ailments

This section is designed to help you alleviate specific health problems through care fully created Yoga routines that you can practice at home. In addition to Yoga pos tures, the discussion of each ailment includes nutritional and lifestyle advice that is medically sound while fitting into the overall Yoga approach to health and healing. We feel it's important that you read Chapters 1-5 and become familiar with vari ous breathing and relaxation techniques prior to beginning any of the Yoga rou tines in Chapters 7—14. If you have a serious health condition, please consult your physician for diagnosis and treatment, and mention your intent to use Yoga as a complementary therapy Yoga may not be appropriate in the acute stage of certain ailments, such as a her niated disk or heart disease, but can be extremely beneficial in your recovery. Read the chapter carefully, and check with your health-care provider if you're not sure whether to begin Yoga therapy.

7 The Musculoskeletal System, Back, Knees, Arthritis

arly in my career as a Yoga teacher I attended an international Yoga conI ference in Switzerland. Howard Kent, the founder of a British Yoga and health center, led a workshop called "The Hip Bone's Connected to the Back Bone." Illustrating with charts and diagrams, he explained the musculoskele tal system and how all its parts are tied together. Wanting us to experience the effects of that integration, he asked us to form a circle and walk around the room. After a few laps he said, "Now walk on your toes." Well, as Yoga teachers we were in good shape, but pretty soon we started to notice changes. I expected the balls of my feet to start getting tired and my toes to begin feeling numb. Beyond that, I could feel my calf muscles and knees working harder. To keep my balance, I began to lean forward and look down, thereby changing the natural curve in my back and putting it under stress. After several laps, my body was feeling strained and I had to

97

raise my arms for balance. I looked around the room and it was quite a sight—each person's posture from head to toe was dramatically affected by walking on their toes for just ten minutes. It was a dramatic illustration of how a small alteration in our body's position can have a major effect on its overall alignment. Your body's alignment and mobility depend on the proper relationships between elements of the musculoskeletal system—the muscles, bones, and joints. Conditions that upset the delicate balance of the musculoskeletal system often man ifest as pain in your back, neck, hips, or knees. To understand why Yoga's holistic approach makes sense and how it can help, you need to know a little about the structure of your musculoskeletal system. Let's take a look at your muscles, bones, and joints and see how they respond to Yoga therapy.

ANATOMY I 0 1 Muscles Muscles are the body's most abundant tissue, making up about 23 percent of a woman's body and 40 percent of a man's. There are three different types of muscle in the body: cardiac muscle in the heart; smooth muscle in blood vessels and other organs; and skeletal muscle, which is the type we move voluntarily. Along with tendons and other connective tissues, the skeletal muscles provide both stability and mobility, allowing us to hold ourselves upright and to move. These are the muscles we'll be discussing here. Skeletal muscles provide movement through contractions, working in pairs. The muscle that contracts to provide the movement is called the agonist; its oppos ing muscle, called the antagonist, releases and lengthens during the movement. The practice of Yoga incorporates both the contracting and the lengthening of muscles. When you hold your arms out to the sides and bend them up at the elbow (in a classic "muscle man" pose), your biceps is the agonist, contracting and shortening; and your triceps is the antagonist, stretching and lengthening. When you relax your arms, both the biceps and triceps return to their resting lengths. When you lengthen and stretch a muscle, it opens up space for the rich flow of blood it needs to be healthy. A muscle in good condition stays relaxed at its normal resting length until needed, and it has a greater ability to produce a strong and 98

powerful contraction. An overly stressed muscle can remain chronically tense, restricting blood supply and diminishing its strength. Yoga works primarily through gently stretching and lengthening the muscles, thereby conditioning them to be both strong and supple.

Bones and Joints The muscles govern the movement of the skeletal system, which is composed of bones, joints, and connective tissues such as tendons, ligaments, bursae, and disks. In Yoga philosophy, joint health is a primary goal because it both influences and reflects the body's overall health. While a few joints in the body are immovable or slightly movable, most of the joints are "freely movable" and have elaborate structures. Their complexity is one reason they're particularly vulnerable to injury. A joint is only as healthy as the muscles surrounding it. Relaxed, flexible mus cles lead to a more mobile joint. Art Brownstein, M.D., author of Healing Back Pain Naturally, uses the example of a stream running through the woods. Picture a tree branch jutting out from the bank of the stream into the water. At the branch, the flow of the stream is impaired and you will start to see accumulation of debris. If you remove the branch, you will see the stream quickly return to its normal speed, and it will cleanse itself of the debris that had piled up. Like the unobstructed stream, an open, limber joint has good flow and a healthy, clean surface. A major benefit of Yoga is its contribution to maintaining healthy, flexible joints.

M U S C U L O S K E L E TA L A I L M E N T S The remainder of this chapter encompasses the musculoskeletal disorders typically alleviated through Yoga therapy. Muscle, bone, and joint conditions can be caused by accident or injury, but most often they're the result of problems caused over time by such things as poor sitting posture, incorrect lifting, and even jogging on hard surfaces. Often when these problems are corrected, the corresponding pain diminishes. Many of the muscle and joint pains Westerners have come to expect as a normal part of growing older are not, in fact, inevitable and can be avoided or reversed with Yoga therapy. 99

Back Pain "It's a miracle, Larry." That was music to my ears, even though it was fifteen years after I had treated Robert, a respected screenwriter in Hollywood. He had come to me in desperation, a last-ditch effort to avoid surgery on his chronically aching back. Having seen every specialist in town from orthopedists to chiropractors, he was out of options and still suffering. His diagnosis was "a posterior bulging disk between L4 and L5." In English, an intervertebral disk (a jelly-doughnut-like pad) in his lower back was bulging backward out of its normal position. It appeared that the pressure of the bulging disk on the nerves was causing pain and numbness in his back and down his right leg. I spoke to his orthopedic doctor, reviewed his diag nosis, and got the go-ahead to begin Yoga therapy. (Depending on the disk prob lem, certain types of bending and twisting can cause further damage. A regular group Yoga class, in which individual instruction is usually minimal, would have been a big mistake.) Our one-on-one Yoga therapy treatments began with Yoga breathing to relax the back muscles. I added simple breath and movement patterns, avoiding forward bends and emphasizing gentle arching postures. We discussed his lifestyle, and he admitted spending hours at the computer in a slumped forward position. It was easy to adjust the level of his computer screen so his spine would be upright. The results were stunning. His pain quickly subsided as he responded to the treatment while diligently practicing his Yoga therapy routine twice a day. After a few short months, Robert was able to attend my group class. He knew what to avoid and how to modify postures to fit his condition. Because he lived on the other side of town, he found a good Yoga center near him, and eventually I lost track of him. Years later, walking through the health club, I heard my name called. Grinning and shaking my hand, Robert told me he'd joined a weekly Yoga class and kept up with it, and his back pain had never returned. Even after all these years, he couldn't conceal his enthusiasm as he admitted he'd thought relief from back pain was an impossible dream. Most people experience back pain at some point in their lives, and many miss work or even become disabled because of it. Perhaps 90 percent of people with acute back pain get better within a month. While for a number of people the pain subsides within a few months, others develop chronic back pain that persists for I 00

months or even years. This is the type of pain most likely to be relieved by Yoga therapy. If you suffer from back pain, be sure to read the Yoga Prescription for Musculoskeletal Ailments on page 111 and Yoga for the Back on page 114. When we think of the back, we usually think first of the spine—a partially flex ible column of bones and disks that extends from the base of the skull to the pelvis. It provides the torso's vertical support, and transfers the weight of the upper body through the pelvis and down to the feet. The spine also encloses and protects the spinal cord, a bundle of nerves connecting every area of the body to the brain. The spinal column is uniquely constructed to guard the spinal cord while also provid ing strong but flexible upper body support. The spine is made up of vertebrae and their joints, each of which can move in six different directions. (That's a lot of movable parts, increasing the odds of some thing going wrong.) The vertebrae are bound together by two long, thick liga ments running the entire length of the spine as well as by smaller ligaments between each pair of vertebrae. The uppermost section of the spine, the seven vertebrae of the neck, is known as the cervical spine. The middle section, made up of twelve vertebrae, is called the thoracic spine, which is the longest section of spine. The lower section is called the lumbar spine, which is the inward-curving small of the back that is made up of five vertebrae. The sacrum is both the base of the spine and the back of the pelvis. As the foundation of the higher levels of the spine, the position of the sacrum plays an important role in the THE SPINE overall alignment of your back. Tip the sacrum too far forward for too long, for example, and the curvature of

cervical vertebrae

the whole spine gets distorted and sends you running to your local Yoga therapist. You might think of the spine as running in a straight

thoracic vertebrae

line down the middle of the back, but only if viewed from directly behind. Seen from the side, the spine is curved, with each spinal section having its own charac teristic curve: the cervical (neck) and the lumbar each

lumbar vertebrae

curve toward the inside of the body, and the thoracic and the sacral each curve toward the outside (Figure 1). The spinal curves are important to the structure of front view the body, acting as a kind of shock absorber and a bal- Figure i I 01

ancing mechanism for the torso. Distorting the curves, either by increasing or decreasing them, can have negative effects for our overall health. Since the back's proper alignment is paramount, one of the primary goals of Yoga therapy is to restore and preserve the proper curvature of the spine. The back also consists of a complex musculature, which is tied in with the muscles in your head, arms, and legs. Different muscles in the back can be affected by muscles in other parts of the body. For example, the hamstrings (the back of the thighs) pull on the bottom of the pelvis in a way that tends to affect the lumbar region of the spine. If your hamstrings are tight, they can exert such a tremendous pressure on your spine that they can literally flatten the normal lumbar curve. Peo ple with occupations that involve sitting in one position for long periods of time, especially taxi and truck drivers, often have back pain that can be helped by loos ening up the hamstrings. While most back problems are musculoskeletal (related to muscles, bones and joints, tendons and ligaments), back pain can also be caused by kidney infections, ulcers, gastrointestinal distress, reproductive organ problems, other internal organ disorders, and even cancer. For this reason, if you experience severe or persist ent back pain, it is imperative to receive a diagnosis from a physician. If tests have confirmed that your back pain is not caused by an underlying organ problem or disease and you are not in an acute stage of pain, then starting with a Yoga ther apy program is appropriate and will most likely bring relief. By far the most common back pain is lower back strain. The pain may start suddenly after heavy lifting or twisting, but the structural weakness was most likely set in place long before, through your patterns of movement or as a result of an accident or injury. Women may first notice back pain in pregnancy, and dads can feel lower back strain after carrying their children. If you sit at a desk for long hours leaning forward toward a computer, if you often wear high heels, or if your job involves heavy lifting, you're a prime candidate for lower back strain. Herb was a retired seventy-three-year-old movie producer and pianist who had suffered from serious lower back problems and terrible posture since adoles cence. As he aged, his back pain worsened, but he had found no relief through tra ditional medical channels. Easily the stiffest man I had ever treated, Herb had compounded his back problems by playing the piano with poor posture for years. I started by giving him routines specifically targeted for back and neck problems.

I 02

He was diligent about his daily Yoga practice, and as his symptoms gradually improved, I updated his program to keep up with his progress. Within six months, Herb was engaging in a daily one-hour program and was symptom free after more than fifty years of chronic back problems. While acute back pain usually heals within a month or two, chronic back pain is less responsive to medical and chiropractic solutions. The good news is that chronic low back pain can usually be managed or eliminated by regular practice of simple Yoga therapy techniques, such as in the Lower Back Routine outlined in this chapter. Another type of back pain is the result of damaged THE INTERVERTEBRAL DISK disks. A normal, healthy spine has a wide range of motion, and the intervertebral disks play a big part in this extraordinary flexibility (Figure 2). You know those jelly-filled doughnuts we're not supposed to eat because 1^r_^, they're so fattening? They look a little bit like our inter vertebral disks. Made of a tough outer ring that sur rounds a gel-filled pocket, a disk is positioned between each pair of vertebrae in your spine. Like little shock Figure 2 absorbers, they cushion the vertebrae and soften the forces created by movement such as walking and jumping. You may have heard the term "slipped disk," layper son's language for what's technically called a herniated disk. The disk doesn't really slip, but its outer ring gives way so that the gel inside bulges out from between the vertebrae and can press against the spinal nerves. Disk problems usually cause acute pain and require medical attention. Symp toms of disk disorders commonly include numbness or tingling sensations in the legs and feet, or sharp, immobilizing pains in the back. Note: If you have a disk problem, or if you haven't obtained a diagnosis but you have these symptoms, be sure to consult a physician before starting any Yoga practice. If you have acute pain, begin Yoga only with your doctor's approval. Most disk problems heal on their own over time; however, the pain may be so debilitating or long lasting that your doctor may suggest surgery. Unfortunately, there is no guarantee that back surgery will eliminate the pain. Yoga therapy can be helpful with many disk problems after the acute stage has passed, as long as your doctor feels the movement will not exacerbate your condition. If your doctor

03

approves, follow either the upper- or the lower-back routines described in this chapter, depending on the location of your pain. Remember, if any of the move ments increase your pain—stop. Practice only those postures that enhance your feeling of well-being, and do them gently. Another common contributor to back pain is stress. Many of us are familiar with that tight, tension-filled ache in the neck or shoulders that just yearns to be rubbed or dunked in a hot tub. And someone suffering from undue stress might bend over to pick something up and develop a back muscle spasm, and not be able to get up. Many studies have been performed to investigate the powerful mind—body connec tion, confirming that our mental stress does influence our muscles. If you've been in a car accident or suffered an activity-related injury, your back may be feeling the pain for months or even years afterward. Sometimes the pain leads to dysfunctional movement patterns—that is, you compensate for the pain by adjusting your sitting, standing, or walking posture. This puts your body even further out of balance and can lead to other problems in your back, neck, or hips. The tension in the injured area may leave it feeling chronically "tight" and lacking flexibility. The tightness may interfere with healing by preventing good circulation in the injured area. Since Yoga therapy addresses these problems, it can be a great help in treating injury-related back pain. A carefully practiced Yoga therapy routine, such as the back routines given in this chapter, can help or even completely alleviate the back pain. Your Yoga practice may also help you correct any dysfunctional movement patterns or postures you have developed, a crucial step toward healing.

Kn ees Of all the joints in your body, your knees may be the most susceptible to pain or injury. Our knees are subject to numerous stresses as we go about our daily lives, walking, lifting, and kneeling. When we go all-out in high-impact activities such as jogging, skiing, or playing basketball, we're asking our knees to perform above and beyond the call of duty, especially when we twist and turn, stop and start, or jump. Pain in the knee is usually a direct result of these daily and extraordinary stresses, either from an injury or simply from excessive wear and tear over time.

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Cartilage is found in the knee in three places: under the kneecap, on the ends of the femur and tibia, and in the joint itself. Abnormal wearing of the cartilage can be caused by trauma or overuse of the knee. Cartilage can be torn by forcefully rotating the knee beyond its endurance. Pain can vary from mild to severe, and there may be swelling. When the tendons are injured and become inflamed, it is known as tendinitis, which can be quite painful. It is usually caused by a repetitive motion that overstresses the tendon; "tennis elbow" results from the repeated swing of the tennis racket over weeks, months, or years. Tendinitis of the knee is sometimes referred to as "jumper's knee," since the high impact of jumping strains the tendons. Pain is usually mild during normal activity but severe when the tendon is being overused, such as in high-impact aerobics or running. The extreme version of tendinitis is a ruptured or torn tendon, which most often occurs in older people whose tendons are weaker and less elastic. When this happens in the knee, it's quite painful and makes bending or extending the leg difficult. Car accidents and contact sports are often responsible for ligament injury, when there is a direct blow to the knee area. These injuries are also commonly caused by sudden twisting motions, as in the quick stop-start of basketball. Liga ment sprains, strains, or tears usually cause pain, swelling, and difficulty walking; often, the knee will buckle and there will be a popping sensation. When the cartilage of the knee degenerates and gradually wears away, it is known as osteoarthritis. It's usually caused by excess stress on the joint over an extended period. (Be sure to read the more detailed explanation of arthritis in the next section.) Because knee ailments and patients vary so much, so do their treatments. Your physician will make decisions on how to treat your knee based on the exact nature of the injury or condition, the severity of it, your health history, and your personal preference. Treatments for knee injuries can involve pain medication, physical therapy, exercise programs, applying ice, wearing a brace, limiting activity, or any combination of these. If your knee condition is severe, your doctor may recom mend surgery. The Yoga therapy routine for knees in this chapter is an excellent tool for recovery from a knee injury or disease, and it may be especially effective in reha bilitation from knee surgery to begin restoring flexibility to the joint and strength

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to the muscles. Be sure to work in conjunction with your physician and/or physi cal therapist to maximize your healing and avoid further injury. If you normally approach exercise and sports with the "no pain-no gain" atti tude, you might as well drop it right now. It's not going to help you, especially when you're dealing with a joint as vulnerable as the knee. I know all too well what can happen when we Westerners insist on tackling Yoga with a "just do it" mentality Twenty years ago, I took a month-long Yoga teacher training course at a remote ashram in southern India. The courses and meals were taught and served on the floor. One of the goals was to sit in the full lotus posture as much as possi ble, which was very easy for the Indians. Yoga postures were developed in India for people who traditionally used very little furniture, squatted daily for numerous rea sons, and kept their knee and hip joints very limber. However, for a mid-thirties, ex-jock male from California, a comfortable lotus position is more of a two-year plan than a thirty-day intensive. Unfortunately, I let my competitive spirit get the best of me. One morning during meditation, I finally twisted my legs far enough to sit very painfully in the full lotus posture. Exuberant because I had reached "the goal," I ignored the warning signs coming from my knee joints and eventually felt a deep burning in my right knee. After another few minutes I also felt a tearing sen sation. I knew something was wrong, but didn't realize until I returned to the United States that I had torn the cartilage in my right knee. I tried for two years to fix it through Yoga and physical therapy but finally had to resort to arthroscopic surgery. Eventually, I was able to use Yoga therapy to assist in my post-op healing, and I've kept my knees healthy ever since. The point to remember is that the Yoga perspective never involves increasing the pain as a means to an end. As you begin to apply Yoga therapy for recovery from your painful knee, listen to your body. Challenge but don't strain yourself. Don't push yourself into any Yoga posture that causes or increases pain. If you're suffering from pain in your knees, it is crucial that you see a physician for diagnosis and treatment. People often seek help from a Yoga teacher or thera pist when the pain first hits, but the time for Yoga therapy is not in the acute stage, which usually involves severe pain and inflammation. Once you are on the road to recovery and you want to enhance your body's healing process, you should get your doctor's okay before starting a Yoga therapy program. If you suffer from a painful knee, be sure to read the Yoga Prescription for Musculoskeletal Ailments on page 111. I 06

Arthritis Turn on the television any day of the week and you'll be bombarded by commer cials aimed at arthritis sufferers. The message is that arthritis equals pain—pain that keeps us from playing the piano, enjoying a round of golf, or holding our grand children. Arthritis is so common in our culture that most people, including doc tors, have come to accept it as a natural part of growing older. Even though arthritis is not life-threatening, it can steal away your quality of life, forcing you to limit or stop not only the physical activities you enjoy but those you need to get you through the day—like walking, dressing, and cooking. About forty-two million Americans—nearly 20 percent of our population— suffer from some form of arthritis. A whopping 85 percent of people over age sixty-five show evidence of arthritis on x-ray, and half of those experience symp toms.1 It has a huge impact on work and is second only to heart disease as a reason that people leave employment. Arthritis has everything to do with movement, which is one reason Yoga ther apy can be particularly effective for helping it. If you have arthritis, you may be so sore that you curtail your movements. When you don't move enough, your joints freeze up and become stiff, which increases the pain, making you even less likely to move. It's a vicious circle, and the longer it continues, the more functions you may lose. Movement also can be one of the causes of arthritis, particularly stressful or destructive movement patterns over time, and the pain of arthritis can be assuaged through the right kind of movement. The word arthritis means "joint inflammation," and there are more than one hundred arthritic diseases, each causing pain, swelling, and stiffness in the joints. The most common type is osteoarthritis. It's sometimes called degenerative joint disease, or wear-and-tear arthritis. Osteoarthritis means that the joints have worn down over time. Repetitive overuse or injury causes cartilage to be destroyed, leaving the ends of the bone unprotected. The joint then loses mobility and becomes painful. You can get osteoarthritis in the joints of your fingers, feet, hips, knees, or spine; but it's improbable you'd have it in your wrist, elbows, shoulders, or jaw. Arthritic symp toms in these areas are more likely another arthritic condition such as rheumatoid arthritis. I 07

Rheumatoid, or inflammatory, arthritis is the second most common type of arthritis. An autoimmune disorder causes your own antibodies to attack perfectly healthy joint tissues, causing extreme swelling, pain, and redness. The inflamma tion can jump like fire from one joint to the next, and even into organs. Unlike osteoarthritis, it causes pain and swelling in many joints and locations, not just a specific area. The inflammation is extremely painful and leads to permanent joint damage. But arthritis affects more than just your joints—your muscles take a hit, too. The National Arthritis Foundation has determined from multiple research projects that much of the pain in a severely arthritic joint is from the muscles, not from inside the joint. Dr. Art Brownstein likens it to putting a cast on a completely healthy arm and leaving it on for a year. When you take the cast off, your arm would be rigid and sore, not because of the joints but because the muscles have atrophied. They'd be weaker, thinner, shorter, tighter, and stiffer. It would become very painful to use them. Similarly, arthritis makes you behave as if your limbs are in a cast unable to move, leading to atrophy, so the aching joint is compounded by aching muscles. Relief is impossible without proper exercise to move the joints and rebuild the muscles. If you have your arthritic knee replaced with a shiny new tita nium model but you don't begin a regular stretching and exercise program, even tually your pain will be the same as it was before the surgery, because of those atrophied muscles. Just because you have achy joints, don't assume you have arthritis. Overuse injuries can result in other conditions such as tendinitis, bursitis, or carpal tunnel syndrome. As always, get diagnosed by a physician before jumping to conclusions. Of all the testimonials in this book, the one closest to my heart is from my own brother. Harold Payne is a well-traveled performing songwriter with extensive credits including more than hundred recordings by artists ranging from Patti LaBelle to Rod Stewart to long time collaborator, Bobby Womack. At age thirtynine, Harold was diagnosed with ankylosing spondylitis (AS), a severe form of inflammatory arthritis with no cure. AS affects the spine by attacking the joints, eventually fusing them. It is sometimes referred to as "bamboo spine" and can also affect other joints, such as the shoulders, hips, knees, and feet. Harold decided to use every resource possible to make the best of the situation. He tried chiropractic treatments, physical therapy, and water exercise in addition to

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regular Yoga therapy sessions with me and world-renowned Yoga master T. K. V. Desikachar. Under the guidance of a rheumatologist, Harold took nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and suppress inflammation. Another important factor was education from the Spondylitis Association of America. As a result of his holistic Yoga Rx approach, sixteen years after diagnosis Harold is a role model for AS. He stands tall with good posture, does not need medication, and participates in regular group Yoga classes. He continues to travel and perform internationally and believes his positive attitude despite the illness has had a major impact on his health. The bottom line on arthritis is that there is no cure. Once the disease gets started, nobody is sure whether it can be completely stopped in its tracks. However, contemporary scientific research and ancient Yoga philosophy both agree it's pos sible to slow it down and to ease symptoms enough to bring back your enjoyment of life. For an excellent in-depth resource, I recommend the book Preventing Arthri tis by Ron Lawrence, M.D., Ph.D., and Martin Zucker. If you suffer from arthri tis, be sure to read the Yoga Prescription for Musculoskeletal Ailments on page 111, and Yoga for Arthritis on page 145.

T h e Yo g a A d v a n t a g e f o r Musculoskeletal Ailments Both of the authors of this book were introduced to Yoga because of serious, longterm musculoskeletal pain. We tried numerous remedies without success and finally found lasting relief through Yoga therapy. We're each aware of many others with the same experience. So in our opinion, Yoga practiced properly and consis tently is one of the best ways, if not the best way, to manage pain in your muscles, bones, and joints. The benefits of Yoga for these ailments are numerous and in many ways unique among all types of exercise. The routines given in this chapter will relax your entire body with Yoga breathing and create a union of your body, breath, and mind. You will gently stretch and strengthen your muscles without worsening any existing pain. The asymmetrical postures will stretch each side of your body area separately,

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important because the strength and flexibility of the muscles on either side of the body are frequently uneven from long-term unequal use. Yoga promotes circula tion to the injured area, while strengthening the muscles and loosening up chronic painful contractions. The Yoga therapy routines in this chapter are designed not only to enhance the health of your muscles but also to improve the condition of your joints. Unlike other exercises that may continue to stress your joints, in Yoga you move slowly and gently, practicing postures that gently pull the joint surfaces apart. This is fol lowed by postures that stretch and strengthen the surrounding muscles to support the joint. Yoga also works to correct improper movement patterns that may be causing joint pain, through repetition of the Yoga routine to establish a more healthy range of motion. The combination of stretching, strengthening, and cor recting movement patterns increases joint flexibility, supporting healing and allow ing pain to diminish. Since many of us are at risk for muscle and joint problems at some point in our lives, the Yoga routines in this chapter can be used preventatively. We especially encourage "weekend warrior" type athletes to practice the routines to reduce the risk of injury from tight muscles and unhealthy joints. People with osteoporosis can improve their balance and overall strength by practicing these routines, to reduce their risk of falls that can lead to bone fracture and subsequent debilitating pain. While the positive effects of exercise on joint problems have been accepted in the Yoga culture for centuries, the idea is fairly new in the scientific community. Recently, researchers at Philadelphia's Hahnemann University and the University of Pennsylvania School of Medicine presented a paper suggesting that correctly performed Yoga may actually alter cells and protect cartilage tissue, preserving the function of joints.2 Various studies are under way to explore the medical basis for the link between Yoga and joint health. In years gone by, if you had a knee or back ailment you were given strict instructions to stay off of it. But evidence since the 1980s has turned that advice on its head, with study after study proving that musculoskeletal ailments only get worse with inactivity. So now the old axiom "use it or lose it" is applied to most knee and back problems, and is especially true for those who have arthritis. Numerous studies have now shown that the best way to prevent and treat arthritis is to keep moving. The U.S. Centers for Disease Control and Prevention released a report to counter mistaken recommendations in the past that persons I I 0

with arthritis should not exercise because it would damage their joints.3 Most physicians recommend a program of flexibility, strengthening, and endurance exer cises, which together can improve your general sense of well-being, decrease pain, and possibly even slow the arthritic process. Yoga therapy is uniquely effective for recovery from joint problems because if you do it according to the instructions, there is no bouncing, no impact, and no pushing yourself beyond your limits. Yoga provides exactly the kind of movement an arthritic joint needs, and if your arthri tis is severe, Yoga might be about the only exercise you feel you can do. Yoga has another advantage specifically for rheumatoid arthritis, in that this dis ease appears to be worsened by stress. Several studies have shown that a program of exercise and stress reduction can greatly reduce the flare-ups of rheumatoid arthri tis. A major study published in Rheumatic Disease Clinics of North America suggested that therapies focusing on calming the mind, relaxing the body, and improving general health considerably reduced patients' pain and may have even promoted healing of the arthritis.4 While there are reams of anecdotal evidence establishing the effectiveness of Yoga for musculoskeletal pain, a landmark paper titled "Asana Based Exercises for the Management of Low Back Pain" was the first to scientifically support it.5 Con ducted at the Indian Institute of Technology, the study involved patients with lower back pain who were given a series of Yoga postures to perform regularly. After six months, 70 percent of the participants reported significant improvement, with near normal mobility and absence of pain. Those whose back pain continued also admitted they had not practiced the Yoga regularly.6 The results of this study per fectly mirror our experience with patients suffering musculoskeletal pain: When they commit to a regular Yoga therapy practice, most find relief fairly quickly. If you apply Yoga's holistic approach, looking at all the factors in your life that could be contributing to your pain, you may find that your ailments will heal themselves better than you ever thought possible.

T h e Yo g a P r e s c r i p t i o n f o r Musculoskeletal Ailments Develop a regular exercise program for overall fitness and cardiovascular conditioning. Avoid activities that cause intense pain. I I I

Swimming or exercising in the water is an excellent way to complement your Yoga therapy routine. It will strengthen your muscles and keep you flexible, without putting pressure on your joints. An excellent resource for water exercise is The Water Power Workout by Robert Forster, P.T., and Lynda Huey, M.A. Cycling and walking are also good forms of low-impact cardiovascular exercise. To avoid stress on your joints, aim for short but frequent exercise ses sions. Look at your patterns of moving and carrying. Be creative in finding ways to reduce stress on your back and your knee and hip joints: Use your legs when picking things up, use carts with wheels when pos sible, carry lighter loads, or simply get someone else to do the heavy lifting. Take frequent breaks in repetitive motion. Decrease your sedentary time. If you are required to sit at a desk for many hours, take breaks at least once an hour to walk around. Instead of watching television in the evening, try taking a walk (as your pain allows). If you're overweight, losing just ten pounds can significantly reduce the strain on your knees and back, relieving arthritis and other types of pain. Eat a wholesome diet to increase your general sense of well-being, mak ing sure to get plenty of calcium for healthy bones. You can get enough calcium by taking a supplement or including in your diet calcium-rich foods, such as dairy products, salmon, and dark green leafy vegetables. Keep in mind that Yoga therapy is best once you're out of the acute stage of pain. The Yoga routines in this chapter are excellent for chronic mus culoskeletal pain problems and rehabilitation from surgery or an acute episode. Talk to your doctor about using pain relievers and/or nonsteroidal anti inflammatory drugs such as ibuprofen and acetaminophen. Make a serious effort to reduce the mental stress in your life, which often shows up as pain in your back or neck and which can exacerbate arthritis. Doing Yoga is a stress buster. I I 2

Wear low-heeled shoes that fit properly and give good support to help maintain your balance and leg alignment. Glucosamine and chondroitin sulfate have been in the news lately, being touted as arthritis remedies. Each is a natural substance found in and around cartilage. If you are diabetic or obese, you should stay away from glucosamine. We recommend you discuss with your doctor whether these supplements are appropriate for you. Capsaicin, a component of red hot peppers, has been shown to provide arthritis pain relief when applied as a skin preparation. It appears to do more than just mask the pain, providing long-term relief from pain when used regularly. It is available in over-the-counter preparations, but should be used with extreme caution because even a miniscule amount in your eyes can cause severe burning and irritation. Approach Yoga and any other exercise slowly, especially when joints are stiff or muscles are tight. Being too aggressive can make it worse. Practice the appropriate Yoga therapy routine from this chapter. Start with two or three days a week, working toward five to six days a week.

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A

FOR

MUSCULC

Yo g a f o r t h e B a c k Lower Back

The following is a program for lower back strain, or for the rehabilitation of chronic back pain, similar to the one I devised for Herb (page 102). When you begin, do only Phase One postures, those marked with an arrow (->), for two to four weeks. This will take about twenty minutes. When you are ready for Phase Two, use all of the postures in the order they are presented. Phase Two will take about thirty min utes. Use Belly Breathing (page 41) or Focused Breathing (page 39) through out. As you become more comfortable, you can incorporate the more advanced breathing technique called Victorious Breath (page 44). Ideally, practice the rou tine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week. Caution: This routine is not for anyone in acute or severe pain. If your pain is accompanied by other symptoms, such as numbness or weakness in your legs, it is advisable to check with your doctor before using this program.

Bent-Legs Corpse This is the classic posture for relaxation of the mind—body. Bending your legs sup-

1. Lie on your back with your arms at your sides, palms up. 2. Bend your knees with your feet on the floor at hip width. If your head tilts back or if your neck or throat is tense, use Stay in the posture for 8 to 10 breaths. 3. Relax with your eyes closed.

♦ Knee to Chest Lying Arm Raise with Bent Leg Bent-Leg Hamstring Stretch Cobra The Cobra increases flexibility to the lower back and strengthens the arms, chest, and shoulders. It opens the chest to promote a deeper breathing pattern. Caution: If the Cobra causes any pain or discomfort, replace it v (described next). If both postures cause discomfort, leave them out 1. Lie flat on your belly, legs at hip width, with the front of your feet on the floor. If you have lower back problems, it is important to separate your legs slightly wider than your hips and to turn your heels out. 2. Rest your forehead on the floor and relax your shoulders. Place your palms on the floor with your thumbs near your armpits and your fingers facing forward. Your elbows should be bent close to your sides. 3. Inhaling, engage your back muscles, push your palms down against the floor, and lift your chest and head, looking straight ahead. Leave the front of the pelvis on the floor and keep your shoulders dropped and relaxed. Push your self as high as feels comfortable, keeping your elbows bent, unless your back is very flexible. To make this easier, move your hands farther forward. To make it more challenging, move your hands farther back. 4. Exhaling, lower your torso and head slowly back to the ground. 5. Repeat the lift 6 to 8 times.

S p h i n x ( S u b s t i t u t e f o r C o lor a)